Cases reported "Death"

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1/69. Death in the home: the doctor's responsibility.

    The role physicians assume when patients die at home is nebulous and ill defined. Beyond the traditional function of providing comfort and condolence to family members, the physician's duties are directed toward how our society deals with the bureaucratic and legal aspects of death. statistics are maintained regarding the numbers of deaths in municipalities and states and the causes of death, and those numbers are used by individuals and organizations for a multitude of legal, medical, and political purposes. The state also has an obvious interest in uncovering and prosecuting crime. The physician has a vital part to play in providing essential medical information for those record-keeping, statistical, and legal purposes. physicians need to be mindful of the important functions being served when they are asked to complete death certificates and to report cases and provide information to the medical examiner. As with many other physician activities, the information we provide about our patients' deaths serves a singular societal need; thus, we should view that function not as a burden but as a vital aspect of the enriching and enobling work that is uniquely ours.
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2/69. Near death: a nurse reflects.

    After reading about near-death phenomena in the December issue, this nurse was inspired to share her own experience. Her story and observations may help you better understand and help patients who've been to the brink of death and back.
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3/69. injections and the fear of death: an essay on the limits of biomedicine among the Dagomba of northern ghana.

    This article offers a cultural ("indigenous") explanation of why people in their quest for therapy sometimes reject biomedicine. The argument is that in the current debate over the power of biomedicine, there is a lack of scrutiny of its "failures", i.e. of why people occasionally refuse to accept the offers of biomedicine and its most powerful therapy, injection-therapy. After introducing the problem, the relevant literature and the methods used, the article proceeds by first using historical material regarding vaccination campaigns and the treatment of endemic diseases in ghana and comparative data from elsewhere in africa to show that people may be ambivalent and have a mixed view of the power of biomedicine. In the context of their experiences, people (possibly, in particular, older ones) have come to know both the (early) failures as well as the successes of injection-therapy. Turning to the ethnographic present (1990-1997) the record of Dagomba notions of health and illness as well as two cases are analyzed to define this ambiguity also among younger members of Dagomba culture. Thus, the article oscillates between ethnography and history to define people's ambivalence and the conflict between biomedicine and local understandings.
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4/69. Clinical supervision, death, Heidegger and Freud come 'out of the sighs'.

    In his recent paper on clinical supervision, 'Out of the sighs' - an existential-phenomenological method of clinical supervision: the contribution to palliative care', in this journal, Jones weds psychoanalytical ideas with Heidegger's existential-phenomenological concepts to provide a theoretical framework for clinical supervision in palliative nursing. Although this is an interesting undertaking, theoretical diversity is not a simple matter of merely interchanging concepts. Rather, it is a complex process that must account for varying philosophical assumptions upon which any theory attempts to explain or understand reality. This paper examines the major themes identified by Jones. In particular, it focuses on the spirit of ontological hermeneutics and psychoanalysis, represented by their respective founders, Heidegger and Freud, and in general, refers to other thinkers and ideas mentioned by Jones - as for instance, Schon's reflective practice, Polanyi's personal commitment, Husserl's lived experience, Schutz's intersubjectivity and Yalom's existential disidentification. Here, discussion concerns the subject-object polarity. The paper argues that many of these philosophies are incompatible. In particular, psychoanalysis and existentialism imply inconsistent aims in that psychology does not equate with fundamental ontology - and Jones has not adequately distinguished between these in his supervision discourse. The implications of the accompanying conceptual problems for the practice of clinical supervision in palliative nursing are exemplified by Jones's case study of Lindsey, a dying patient.
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5/69. Is it ethical to practice intubations on the deceased?

    One-third to one-half of emergency departments in the united states and australia perform endotracheal intubations (ETI's) on the newly dead. Sixty-three percent of emergency medicine and 58% of neonatal critical care training programs allowed procedures to be performed on patients after death; only 10% of these programs required family consent for this practice. This article reviews the arguments for and against this ethical issue. A case study is included to highlight the issue's complexity, and to assist readers in identifying their beliefs (and those of their institutions) about the tissue. An overview of ethically related terms, definitions, and theories and a decision-making model are included to establish a knowledgeable baseline for dealing with any ethical issue.
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6/69. At one with death: destructive narcissism.

    In this paper, narcissism is considered to be the relation of self with an idealized internal object, and narcissus's romance with his reflection is taken to be a two-party affair. Destructiveness, an inborn capability, is distinguished from destructive narcissism, a two-party situation between the self and a sadistic internal figure built on the idealization of power. Too often, only half the narcissistic pair is analyzed. The internal object becomes the persecutor of self, while the sadism of self, projected onto the persecutor, goes unanalyzed. This paper takes up a clinical solution: how the analysis can seize the destructive internal object and resolve it down to its nucleus, the self.
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7/69. life after death: a practical approach to grief and bereavement.

    This consensus paper describes the essential skills that clinicians need to help persons who are experiencing grief after the death of a loved one. Four aspects of the grieving process are reviewed: anticipatory grief, acute grief, normal grief reactions, and complicated grief. Techniques for assessment and recommendations about interventions and indications for referral are provided for each aspect.
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8/69. Cardiac death after autologous stem cell transplantation (ASCT) for treatment of systemic sclerosis (SSc): no evidence for cyclophosphamide-induced cardiomyopathy.

    In patients with systemic sclerosis (SSc) treatment-related mortality after autologous stem cell transplantation (ASCT) appears to be increased as compared to patients with hematological malignancies. In our phase I/II study on ASCT in autoimmune diseases a patient with SSc died on day 2 after ASCT. Here we report the results of the autopsy which revealed advanced pulmonary and cardiac fibrosis as the most probable cause of death. In spite of detailed technical examination before enrollment, the cardiopulmonary function tests did not reflect the advanced stage of the disease. We conclude that in selected patients with SSc, biopsies should be performed to reduce mortality after ASCT.
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9/69. To die young, to die old management of terminal illness at age 20 and at age 85: case reports. Death and dying in an 85-year-old woman.

    In conclusion, preparing for death is a developmental task. Whether faced with acute illness or old age, the inevitability of death comprises part of the mental life of all of us. As with all other developmental tasks, the quality of mastery depends on mastery of earlier developmental tasks and the related adaptive capacities of the ego. Mrs. F. had the good fortune of family support, concrete help in the household, and casework treatment that many of the aged do not have. However, past experiences, coupled with an ability to work out problems and to utilize available external resources, helped her to work through feelings about her own impending death.
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10/69. Incapacitation or death of a socially isolated parent or carer could result in the death of dependent children.

    A study was undertaken to investigate features of infant and childhood fatalities that were a consequence of care by socially isolated adults suffering from significant medical conditions. autopsy records at the Forensic science Centre in Adelaide from July 1996 to June 2001 were searched for all cases where infants or children had died as a result of the incapacitation or death of an adult carer. A total of two cases were found, involving three children. The carers were aged 51 years (grandfather) and 20 years (mother) and had died at home from ischaemic heart disease and epilepsy, respectively. The children were all boys and were aged 1 year, 2.5 years and 3 years. The child victims had died of dehydration following the adult deaths. These cases demonstrate that infants and young children in the care of socially isolated and unwell adults could be at risk of significant injury or death if the carer dies or becomes incapacitated. The provision of medical-emergency buttons for such families, and/or the setting up of regular contact with medical clinics or neighbours are steps that could be taken to diminish the risk of such an outcome.
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