RESUMO
Objetivos. Conocer la práctica y los factores asociados a la limitación del esfuerzo terapéutico y las órdenes de no reanimación en una planta de hospitalización convencional de Medicina Interna de un hospital comarcal. Material y métodos. Estudio retrospectivo en el que se han buscado los pacientes que recibieron órdenes de no reanimación (ONR) y los pacientes fallecidos entre los ingresados en Medicina Interna entre enero y mayo de 2011 en el Hospital de Villarrobledo. Se describen en este grupo de pacientes aquellas actuaciones que pueden calificarse de limitación de tratamientos de soporte vital (LTSV). Resultados. En total se han analizado 106 casos, de los cuales 80 recibieron ONR (10,2% de los ingresos durante este periodo). Cincuenta y cuatro pacientes recibieron alguna otra actuación de LTSV. La información encontrada sobre los motivos y la comunicación con el paciente y familiares es incompleta en la mayoría de los casos. No se han encontrado diferencias entre los pacientes fallecidos con y sin LTSV o con y sin ONR. Conclusiones. Debe mejorarse el registro de los motivos que llevan a tomar las decisiones de LTSV/ONR, así como de las personas que participan en estas decisiones, sea el médico, familiares o el propio paciente(AU)
Objectives. To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. Material and methods. A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. Results. A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. Conclusions. The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions(AU)
Assuntos
Humanos , Masculino , Feminino , Medicina Interna/ética , Medicina Interna/métodos , Medicina Interna/organização & administração , Estudos Retrospectivos , Prognóstico , Condições Sociais/tendências , Reanimação Cardiopulmonar/mortalidade , Reanimação CardiopulmonarRESUMO
OBJECTIVES: To determine the practice and associated factors of limiting therapeutic effort and do not resuscitate (DNR) order in a general Internal Medicine ward in a regional hospital. MATERIAL AND METHODS: A retrospective search was performed to find patients who received do not resuscitate orders and patients who died, among those admitted to Internal Medicine between January and May 2011 at the Hospital of Villarrobledo. The limitation in therapeutic effort (LTE) in this group is described. RESULTS: A total of 106 cases were analyzed, 80 of them received DNR (10.28% of admissions during this period). Fifty four patients received other LTE. The information on the reasons and communication with the patient and family was incomplete in most cases. No differences were found between patients who died with and without LTE or with and without DNR orders. CONCLUSIONS: The information on the reasons that lead to LTE/DNR orders decisions should be improved, as well as the information on the people involved in these decisions.
Assuntos
Admissão do Paciente , Ordens quanto à Conduta (Ética Médica) , Suspensão de Tratamento/estatística & dados numéricos , Idoso de 80 Anos ou mais , Feminino , Hospitais , Humanos , Medicina Interna , Masculino , Estudos RetrospectivosRESUMO
The Ocean Anoxic Event 1 (OAE-1) in central sites of the Basque-Cantabrian Basin exhibits very reducing depositional conditions of sedimentation. These sedimentation events have left a distinct mixture of hydrocarbons that are represented by C22-C30 n-alkanes with a predominance of the even-carbon-number homologues, high relative proportions of squalane and C16-C24 n-alkylcyclopentanes predominated by n-undecyl-, n-tridecyl- and n-pentadecylcyclopentane. Other minor compounds encompass a series of C18-C21 n-alkylcyclohexanes and C18-C24 dimethyl n-alkylcyclohexanes maximized by the even-carbon-number homologues as well as iso- and anteiso-alkanes. This unusual distribution of n-alkanes in this environment provides a new case for comparison with previously reported hypersaline and phosphorite sedimentary deposits where the occurrence of similar n-alkane distributions was reported. In the present case, these major n-alkanes and squalane are indicative of transformation under strong reducing conditions. In contrast, the occurrence of the alkylcyclopentanes, irrespective of the presence of even-carbon-number n-alkanes or squalane, suggests that reductive cyclization of fatty acids is less dependent on strong reducing conditions.
