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PubMed2003

[Death].

Intercultural factors are essential for reflection. In this article, the authors deals with a more direct vision on the special edition about Grief and Mourning, about the topic which lies in the depths of all of our consciences: death and the question what lies beyond death? The author provides us elements to reflect about concepts, some accepted in various cases, rejected in others, but always polemical, which help us to penetrate farther into the real mystery of life: death and what follows death.

Death↗
PubMedDate not supplied

[From the introduction to the possibility of moving beyond immunization obligation: considerations on the need for a guided procedure].

In Italy until sec. XIX, the beginning of vaccination duty allows to obtain some weighty aims in Public Health, like small pox eradication, polio and diphtheria elimination, or like the great reduction of tetanus and hepatitis B incidence. At the some, however, the vaccination duty doesn't allow to develop a "vaccination conscience" to do to accept the vaccines like the most important instrument, for effectiveness and utility, in the infectious diseases prevention. So, if from a side it's necessary to leave the vaccination duty from the another side it's necessary to make e leaded way of health education in the people and it's necessary to make a share of resources and aims in the sanitary world.

Immunization↗
PubMedDate not supplied

[Anesthesia with high dosage fentanyl in coronary patients: effects of pretreatment with droperidol and diazepam].

The Authors have considered the effects of droperidol or diazepam treatments in patients undergoing high-dose fentanyl anesthesia in cardiac surgery. Twenty patients have been examined and divided in two groups: group A received droperidol (0.2 mg.kg-1) and group B diazepam (0.1 mg.kg-1) five minutes after fentanyl anesthesia induction (500 micrograms.min-1) to reach the "sleep dose". The diazepam pretreatment, as regards droperidol, reduces a dose of fentanyl necessary to obtain the conscience loss (21.5 +/- 2.5 micrograms.kg-1 vs 28 +/- 2.9 micrograms.kg-1). Hemodynamically the droperidol group is very stable, whereas the diazepam group shows certain myocardial depression and less protection at the OTI time.

Anesthesia↗
PubMedDate not supplied

[Paradoxical bradycardia and hemorrhagic shock].

We report two cases of paradoxical bradycardia associated with acute hemorrhage and hypotension in conscious patients who had no antecedents of myocardial disease. In some cases of massive and rapid hypovolemia the occurrence of bradycardia may constitute a protective reflex directed to improve ventricular filling. This reflex is probably mediated by a vagal mechanism which acts on a previously increased sympathetic nerve tone and tends to maintain systemic vascular resistances and keep a cerebral blood flow high enough to preserve conscience level. We discuss the differential diagnosis with vasovagal syncope which can also occur during the initial phases of acute hemorrhage and during the preterminal bradycardia that develops during the so called "irreversible phase" of shock. Paradoxical bradycardia during hemorrhagic shock is always a sign of important bleeding that requires a rapid reposition of volemia. Administration of vagolytic agents is contraindicated since they can favour the occurrence of severe cardiac arrhythmias.

Aged↗
PubMed2004

[Handling of the petition for carrying out ritual slaughter (the area of conflict of the official veterinarian between the special requirements and legal possibilities). Juristic view].

With the introduction of Art. 20 a GG in August 2002 the moral thought of animal protection has become a constitutional principle. Now an accommodation between animal protection on the one hand and with religious freedom (undisturbed practice of religion), the right to free development of personality and the right to free choice an practice of an occupation on the other hand has become necessary. If somebody is able to substantiate a claim because of compelling religious reasons, the appropriate authority has still to grant him a certificate of exemption for ritual slaughtering pursuant to paragraph 4 a Abs. 2 Nr. 2 animal-protection-act. The following text tries to explain the conditions precedent to get a permission in detail. The author affirms, that the authorities are bounded by the law. Veterinarians as appropriate authorities are not allowed to turn downed an application on reasons of conscience.

Animal Rights↗
PubMed2004

Three Australian whistleblowing sagas: lessons for internal and external regulation.

The protracted and costly investigations into Camden and Campbelltown hospitals (New South Wales), The Canberra Hospital (Australian Capital Territory), and King Edward Memorial Hospital (Western Australia) recently uncovered significant problems with quality and safety at these institutions. Each investigation arose after whistleblowers alerted politicians directly, having failed to resolve the problems using existing intra-institutional structures. None of the substantiated problems had been uncovered or previously resolved by extensive accreditation or national safety and quality processes; in each instance, the problems were exacerbated by a poor institutional culture of self-regulation, error reporting or investigation. Even after substantiation of their allegations, the whistleblowers, who included staff specialists, administrators and nurses, received little respect and support from their institutions or professions. Increasing legislative protections indicate the role of whistleblowers must now be formally acknowledged and incorporated as a "last resort" component in clinical-governance structures. Portable digital technology, if adequately funded and institutionally supported, may help to transform the conscience-based activity of whistleblowing into a culture of self-reporting, linked to personal and professional development.

Australia↗
PubMed2004

[Dignity of the medical toxicologist in the context of medical ethos].

On beginning of article two sources of medical ethics: Hippocratic Oath and Good Samaritan (from the parable of Jesus Christ). First, it is paradigm of medicine from antiquity to present times, second this paradigm describes from side of Christian theology and anthropological dates. From point of sight of personalism of traditional source of medical, they make up foundation to appearance of dignity physician of toxicology. Notion of dignity contains many most important guild of physicians in our times, especially physician of toxicology. Principle part of article analyses dignity of physician in worry about life, co-operation with different doctors as well as in context of conscience and in challenges of future. Progress of clinical toxicology has to be connected with moral values and the dignity of medical profession and physician's status.

Christianity↗
PubMed2004

[Acute confusional syndrome as first manifestation of primary hyperparathyroidism].

Hyperparathyroid crisis is an uncommon clinical state characterized by severe hypercalcemia which can produce an acute confusional syndrome (ACS) or delirium. We are reporting the case of a 58-year male with calcemias greater than 14 mg/dl, that were due to a parathyroid adenoma (primary hyperparathyroidism), and caused his admission in UCI with change in the conscience level, global afectation of the cognitive functions, letargia and disorentiation among other clinical symptoms. The patient was operated by our Service on lower left parathyroidectomy with PTH rapid or turbo assay and decreasing such hormone levels about 75%. After the surgery his evolution was satisfactory obtaining the normocalcemia.

Calcium↗
PubMed2003

[Hans Neuffer (1892-1968). Medical moral philosopher and politician of profession in personal union].

Hans Neuffer had a well established, civil familiary background. He was raised according to Christian values and remained a practising Christian until the end of his life. Before 1945 he was no person in public life. In spite of the fact that he disapproved the Nazi rule, he did not practise open resistance. After World War Two politically guiltless physicians were needed. Neuffer had this quality and on top of that he had a talent for organisation. In the beginning he was medical functionary in his swabian hometown Stuttgart. In 1949 he took over tasks as medical functionary nationwide. Under his leadership the German physicians succeeded in creating the structures of self administration, that still exist today. Big improvements in income were achieved. The German physicians profited from this until the seventy years of the last century. In addition to this the German doctors managed to become fully accepted members of the World Medical Association (WMA). Besides his work as medical functionary, Neuffer was occupied with ethical questions. The premise of Neuffer's medical ethics were the physician's close ties to God. The responsibility to God was more important than responsibility to conscience, science, the people or the government. One of the foundations of Neuffer's ethics lies in the doctor's personality. Like an artist the "true" physician felt an inner calling. He possessed high mental capacity and had special psychological abilities. Such high moral, mental and psychological demands could only be fulfilled in freedom. Freedom required an adequate income and physicians' self administration. This kind of medical ethics fitted well to the political aims of West Germany's General Medical Council. The freedom of the medical profession and independence from society or government were crucial positions. Hans Neuffer was a politically and morally guiltless medical functionary. At the end of his presidency in 1959, West Germany's physicians had achieved all important aims of their political program.

Ethics, Medical↗
PubMed2004

[Integrity in science: a constant concern].

Recently many academies, science foundations and university associations have placed scientific integrity high on the agenda. 'Scientific integrity' falls within the category internal ethical problems in science as opposed to the category external ethical problems (e.g. justification of the choice of the subject of research, independence of research, responsibility for possible applications) and differs from intrinsic ethical problems such as those generated by stemcell research, nuclear fusion, xenotransplantation a.o. Crucial for science is trust by colleagues and peers as well as the wider public. Trust is weakened by published cases of misconduct: fraud, deceit, and infringement of intellectual property. Scientific misconduct and fraud have been a worldwide phenomenon of all times. The borderline between acceptable and unacceptable conduct is often vague. Causes of scientific misconduct include pressure from powerful institutions, economic and financial motives, and own ambition and vanity of the scientists. Hard data on the occurrence of misconduct is lacking, but a present-day increase of misconduct is not inconceivable. Prevention of misconduct include corrective and antecipatory measures, but most important is the fostering of a scientific conscience and at a sense of proper values and standards.

Ethics, Research↗
PubMed2004

[Adhesion to the antiretroviral treatment].

The objective of the therapy antiretroviral is to improve the quality of life and the survival of the persons affected by the VIH through the suppression of the viral replication. Nevertheless one of the present problems is the resistant apparition of stumps to the new medicines caused by an incorrect management of the therapeutic plan; by an incorrect adhesion of the personal processing. Since the therapeutic success will depend, among others factors, and of important form of the degree of implication and commitment of the person affected, is a matter of identifying prematurely the possible situations concomitants (personal factors and of addiction, psycho-social, related to the processing and its possible secondary effects, associated factors to the own illness or even to the relation professional-patient) that can interfere in a correct adhesion. For it is necessary of the interaction multidisciplinary of the welfare team, and fundamental the work of nursing at the moment of to detect the possible determinant factors and the intervention definition of strategies arrived at by consensus with the own person, that they promote it or it improve. The quantification of the degree of adhesion (measure in %) values through various direct and indirect methods and should keep in mind in it takes of therapeutic decisions being able to come to be advised the suspension of the processing until obtaining to conscience to the person affected of the importance of a correct therapeutic compliance.

Anti-Retroviral Agents↗
PubMed2004

The ethics and science of medicating children.

Prescriptions for psychiatric drugs to children and adolescents have skyrocketed in the past 10 years. This article presents evidence that the superior effectiveness of stimulants and antidepressants is largely a presumption based on an empirical house of cards, driven by an industry that has no conscience about the implications of its ever growing, and disturbingly younger, list of consumers. Recognizing that most mental health professionals do not have the time, and sometimes feel ill-equipped to explore the controversy regarding pharmacological treatment of children, this article discusses the four fatal flaws of drug studies to enable critical examination of research addressing the drugging of children. The four flaws are illustrated by the Emslie studies of Prozac and children, which offer not only a strident example of marketing masquerading as science, but also, given the recent FDA approval of Prozac for children, a brutal reminder of the danger inherent in not knowing how to distinguish science from science fiction. The authors argue that an ethical path requires the challenge of the automatic medical response to medicate children, with an accompanying demand for untainted science and balanced information to inform critical decisions by child caretakers.

Adolescent↗
PubMed1992

[Acute organophosphate insecticide poisonings in the province of Almería. A study of 187 cases].

BACKGROUND: The aim of the present study was to analyze the epidemiological and clinical characteristics of poisoning by organophosphorus insecticides in the province of Almería. METHODS: One hundred eighty-seven patients diagnosed with organophosphorus insecticide poisoning were included from 1981-1986. In all the cases a previously established clinic and therapeutic protocol was applied. RESULTS: Eighty-six percent of the patients were males with a mean age of 31 years. The poisoning was accidental in 62% of the cases and attempted suicide in 38%. The via of absorption was cutaneous-respiratory in 57% and digestive in 43% of the patients. All the patients presented florid initial cholinergic symptomatology. The presence of bronchorrhea, tremor-fasciculations, respiratory depression and diminution in the level of conscience was associated with severe intoxication. The quantification of acetylcolinesterase was useful as a diagnostic parameter. Global mortality was 4%. Ten percent of the patients developed delayed signs of neurotoxicity. CONCLUSIONS: The high hospital demand for poisoning by organophosphorus insecticide is of note. Hospital mortality is low. The severity of intoxication is related with attempts of autolysis, digestive absorption, appearance of respiratory manifestations and of the central nervous system and the development of complications.

Acute Disease↗
PubMed2004

[Castleman disease].

A 66 years female, who was since last year under astenia, arthralgias, pimply lesions in spread plates and tests showing eritrosedimentation over 100 mm, anemi, leucocitosis with neutrofilia, policlonal hypergammaglobulinemia, slight proteinuria and IgE on 900. This patient was sporadically treated with corticoids. When made the medical consult had lost 34lb., was under anorexy, as well as dyspepsia. Hemoglobyn 6.9 gr/dl, leucocytes 20000/mm3, neutrofils at 90%, proteinogram the same as former, with hypoalbuminemia. She was taking prednisona, 16 mg/day. When examined showed depress of conscience, astenia, and dermic lesions already quoted. 4 cm nonpainful right axillary adenopaty adhered to deep planes. Medulogram with increased iron, hyperegenerative. Ganglionar biopsia: linfoid hyperplasic process linked to inmune response. Toracoabdominal tomography with adenomegalia in torax and retroperitoneo. Skin biopsia: neutrofilic vasculitis. The patient suspends the 16 mg of prednisona and fever as well as generalized adenopatias come up. After laying aside other ethiologies, and understanding as Castleman Multicentric disease, it is started to supply prednisona 1 mg/kg of weight with a clinical and biochemical fast and outstanding response. After 7 months it was progressively suspended the esteroids and 60 days later, the process fall back; for that, corticoids are restarted, with a good evolution. The illness of Castleman although it is not very frequent, it should be considered as differential diagnosis in those clinical cases that are accompanied with important general commitment, linphadenopaties and respons to steroid therapy.

Aged↗
PubMedDate not supplied

[The primordial genesis of psyche: emergence and formalization].

Although there is no doubt that life was preceded by a purely physical universe from which it emerged, still there are some conceptual blanks which are necessary to analyse in order to make intelligible not only the evolutional origin of sensibility, perception and conscience but also its settlement in the process of evolution and the contribution of psychicsm to the efficiency of organisms as tele-onomical systems. Nowadays science considers that this happens because of a continuous emergence of novelty in organisms with a more and more developed and complex nervous system, which facilitates actions of adaptation seeking optimal survival. According to Zubiri, the basque thinker who we intend to analyse here, the humanization springs up from potentiality of matter, through a process of transformation, systematization and elevation. Intelligence emerges as a result of biological hyper-formalization so that man can survive taking over reality. If this function is increased, it will give richness to psychic life and, as this is a changeable activity, it can admit enlargements, retractions and internal modifications.

Adaptation, Physiological↗
PubMed2005

Temperament and parenting: implications for understanding developmental pathways to conduct disorder.

This article reviews research linking a number of temperamental vulnerabilities that can place a child at risk for developing severe conduct problems. One primary focus of this article is on how certain temperamental vulnerabilities can disrupt normal developmental processes during early childhood, such as the development of emotional regulatory abilities and the development of the affective components of conscience, to place a child at risk for acting in an antisocial and aggressive manner. A second focus of the paper is on how the quality of parenting that a child experiences interacts with the child's temperament to either increase or decrease the child's risk for problem behavior. Identifying those parent factors that can enhance the development of children at risk for conduct problems due to temperamental vulnerabilities could be very important for enhancing interventions for children with severe behavior problems.

Affect↗
PubMed1992

[Abortion from the Catholic perspective].

The embryo possesses the right to life. Therefore abortion is an forbidden act of killing. There is no sufficient reason to justify it. Especially the burden of pregnancy in situations of social conflicts and change of carriere-plans cannot justify abortion. Also there can be no demand of conscience to legitimate an abortion. The Catholic Church itself offers support for women in conflict situations. The Church condemns abortion, not the person, who needs a special attention in such a situation.

Abortion, Legal↗
PubMed2006

[Palliative sedation to the dying].

BACKGROUND: Guidelines for palliative sedation to dying patients were issued by the Council for Medical Ethics of the Norwegian Medical Association in 2001. This study is a follow up of these guidelines. MATERIAL AND METHODS: In 2002 an anonymous questionnaire was sent to 400 hospital departments. After two years, only 12 questionnaires had been returned. In addition to this survey we present data from a survey among a random sample of 1539 doctors. RESULTS: Ten of the 12 treatments which were registered in detail concerned patients with advanced cancer and in great discomfort. Average age was 49. Pain, nausea, convulsions and dyspnoea were the most common symptoms. Nine out of the 12 patients were in pain. In no case the sedation was assessed to have been avoidable with more health care resources. Relatively few patients had been examined psychologically. The decisions were taken by several caregivers, always in accordance with the family's wish. Six of the patients whose conscience level was raised were sedated again. Midazolam and morphine were the two mostly-used drugs; doses used varied considerably. 12% of the surveyed physicians said that one or more dying patients had been given palliative sedation in their department during the last 12 months. INTERPRETATION: Palliative sedation for dying patients is probably used infrequently in Norway, and not to hasten death. In the cases which we have registered, palliative sedation was given to patients in great discomfort.

Adult↗