The Western journal of medicine
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The use of the do-not-resuscitate order has become accepted medical practice. To date, however, no study has been done of how often it is used or factors associated with its use. Reports of all deaths of inpatients occurring during calendar year 1981 at San Bernardino County Medical Center were eligible for study. ⋯ Comparison of reports of those for whom such an order had been written with those for whom no order had been written indicated that a do-not-resuscitate order was not associated with age, sex, ethnicity or pay status. Indices of mental clarity, however, were associated with orders not to resuscitate; those patients residing in nursing homes, and not alert and oriented on admission were overrepresented in the group given this order. Primary discharge diagnosis was also associated with such an order, as was an increased duration of hospital stay.
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Healing is the alleviation of sickness, which includes both medically defined problems of pathophysiology (disease) and personal definitions of not being well (illness). Refugees from Southeast Asia now have a special need for healing because their health problems are changing from those of concern to public health, which are well documented and for which there are known effective treatments, to those that are primarily a personal concern and that are difficult to diagnose and treat effectively because of their chronic nature and their cultural and emotional components. The finding among refugees of physical complaints for which there is no identifiable medical cause is explained by cultural tendencies in Southeast Asia that promote focusing on somatic symptomatology, and by a delayed somatic response to refugee trauma. To prevent escalation of medical intervention, physicians need to be sensitive to Southeast Asians' attitudes toward health and their expectations and apprehensions regarding Western medicine.
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The medical profession has experienced high liability insurance premiums accompanied by widespread use of contingent fees in medical malpractice litigation. It is worthwhile, therefore, to assess qualitatively the merits of contingent fees, the evidence suggesting that they are associated with unjustified litigation and their implications for the medical and legal professions.
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Homoiothermic organisms react to hypothermia by shivering and thermogenesis to retain their euthermic state. This reactive homeostatic mechanism recruits a strong sympathetic response, which must be suppressed by anesthesia and adjuvants during induced hypothermia. ⋯ Proper cardiopulmonary support must be instituted in a patient who has induced or accidental hypothermia at these severely hypothermic levels. Although clinical hypothermia is used to protect the brain and the heart from ischemic insults during an operation, it induces a complex array of physiologic changes in the body that must be appreciated so that optimal care may be provided to a patient.