The Mount Sinai journal of medicine, New York
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The use of advance directives is based on the consensus that physicians should respect preferences expressed by competent patients about future treatments. Patient preferences are, however, subject to change and may be influenced by a number of factors. The purpose of our study was to evaluate the durability over time of decisions made regarding terminal care of mentally intact nursing home patients and the influence of such factors as intervening illness, loss of significant others, and cognitive, emotional and functional decline. ⋯ In light of our findings, we suggest that periodic re-evaluation of these advance directives be performed and that ongoing discussions be initiated with their patients by health care professionals.
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Medical professionalism encourages physicians to place their patients interests above self-interest. In recent years, many medical organizations, including the American Board of Internal Medicine (ABIM), Association of American Medical Colleges (AAMC), and the American Medical Association (AMA), have developed initiatives to strengthen medical professionalism. ⋯ One crucial question facing medical educators is whether the concepts of professionalism can be taught to medical students and residents. This paper draws upon the author s thirty years of experience in teaching clinical medical ethics to provide guidance on how to teach the concepts of professionalism to students and residents.
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Principles of medical professionalism include humanistic values, altruism, ethical and moral behavior, and a lifelong commitment to scholarship and learning. These principles can provide behavioral guidelines to residents, fellows and their teacher-physicians during the formative years of postgraduate training. This short paper presents some of the challenging professional questions raised during these years of training, where medical professionalism may help to guide us.
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A case of subarachnoid hemorrhage following spinal anesthesia for prostate radioactive seed implantation is reported. The implications of the differential diagnosis of post-dural puncture headache are discussed.
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Historical Article
The surgical intensive care unit of The Mount Sinai Hospital: a brief history focusing on contributions to academic critical care medicine and excellence in patient care.
The Mount Sinai Hospital Surgical Intensive Care Unit (SICU) was founded in 1969. Drs. ⋯ Since it was founded, the SICU has been an integral part of the Mount Sinai Medical Center, providing a wide variety of clinical services including critical care, central line placement, and nutritional consultation. As one of the largest training programs in the United States and a frequent contributor to the medical literature, the SICU has also played a vital role in academic critical care medicine.