RESUMO
A 31-yr-old male, captive harbor seal (Phoca vitulina) was evaluated for a 48-hr period of anorexia followed by the onset of seizures. A prolonged seizure failed to respond to anticonvulsant therapy and the animal was euthanized. At necropsy, no significant gross lesions were identified. Reverse transcriptase-polymerase chain reaction testing of brain samples was positive for eastern equine encephalitis virus (EEEV) RNA, and serum was positive for anti-EEEV antibodies by plaque reduction neutralization. Histopathologic evaluation revealed severe and multifocal encephalitis with leptomeningitis, characterized by neutrophilic infiltrates in neuropil, neuronal necrosis, satellitosis, neuronophagia, and perivascular cuffs of lymphocytes, macrophages, and neutrophils. Additionally there was moderate, multifocal, adrenal cortical necrosis. Immunohistochemical staining for EEEV demonstrated viral antigen within necrotic neurons and glial cells. Virus was isolated from frozen brain tissue, sequenced for comparison to other strains, and determined to be a typical North American strain. EEEV should be included as a possible cause of neurologic disease in harbor seals with compatible signs located in geographic regions where vector transmission of EEEV is encountered.
Assuntos
Vírus da Encefalite Equina do Leste/isolamento & purificação , Encefalomielite Equina do Leste/veterinária , Phoca/virologia , Animais , Animais de Zoológico , Anticorpos Antivirais/sangue , Encéfalo/patologia , Encéfalo/virologia , Diagnóstico Diferencial , Encefalomielite Equina do Leste/complicações , Encefalomielite Equina do Leste/diagnóstico , Evolução Fatal , Imuno-Histoquímica/veterinária , Masculino , RNA Viral/análise , Convulsões/etiologia , Convulsões/veterináriaRESUMO
Professional healthcare providers are held responsible for technologic and financial decisions and also for the moral ramifications of their decisions. The authors report the findings of a survey of nurse leaders conducted to determine the key factors that provide help and present challenges as they seek to respond ethically to the dilemmas encountered in the course of their work. Implications for the healthcare industry and the nursing profession are discussed.
Assuntos
Técnicas de Apoio para a Decisão , Ética em Enfermagem , Setor de Assistência à Saúde/organização & administração , Liderança , Enfermeiros Administradores/organização & administração , Supervisão de Enfermagem/organização & administração , Atitude do Pessoal de Saúde , Conflito Psicológico , Tomada de Decisões Gerenciais , Humanos , Enfermeiros Administradores/educação , Enfermeiros Administradores/psicologia , Cultura Organizacional , Filosofia em Enfermagem , Guias de Prática Clínica como Assunto , Inquéritos e Questionários , Estados UnidosRESUMO
The authors compare the results of a May 2002 ethics issues survey of staff nurses who are members of the American Nurses Association (ANA) with those of a February 2000 survey of American Organization of Nurse Executives (AONE) nurse leaders. The findings reveal a common set of key ethical issues that result from the ineffective management of the conflict between clinical ethics and organizational ethics. Implications for healthcare professionals and the organizations that employ them are discussed.
Assuntos
Atitude do Pessoal de Saúde , Ética Institucional , Ética em Enfermagem , Enfermeiros Administradores/ética , Recursos Humanos de Enfermagem/ética , Qualidade da Assistência à Saúde , Conflito de Interesses , Coleta de Dados , Humanos , Estados UnidosRESUMO
By the very nature of their daily work, nurse executives find themselves at the crossroads of the changing and challenging healthcare ethical environment in which clinical ethics and organizational ethics often collide. The authors present the findings of a survey of members of American Organization of Nurse Executives aimed at more clearly identifying the key ethical issues encountered in healthcare organizations by their nurse executives and others. Implications of the findings for healthcare organizations and their managers also are discussed briefly.