RESUMO
AIM: To investigate doctors' response to and understanding of the legal status of advance directives. METHODS: A vignette-based study administered at palliative medicine, oncology, general practice, and geriatric medicine specialist registrar meetings (United Kingdom). Respondents determined the treatment to provide for a patient presenting with a myocardial infarction with or without an advance directive requesting maximum therapy. RESULTS: Response rate 77% (43/56). Twenty-five percent (10/40) of respondents increased the care that they would provide in response to the advance directive (p = 0.004); 77% (33/43) support/strongly support use of advance directives; 51% (22/43) did not know the legal status of advance directives; 44% found that their medical school education was not an important influence on their decision making. CONCLUSIONS: Advance directives requesting treatment can increase the level of care provided by the physician, however, most trainees chose a level of care different from that in the advance directive. Confusion exists among doctors about the legal status of advance directives, which limits their usefulness. Medical education needs to be improved to train doctors to deal with advance directives.
Assuntos
Adesão a Diretivas Antecipadas/normas , Diretivas Antecipadas , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico , Adesão a Diretivas Antecipadas/legislação & jurisprudência , Diretivas Antecipadas/legislação & jurisprudência , Doença de Alzheimer/complicações , Competência Clínica/normas , Compreensão , Cuidados Críticos/organização & administração , Currículo/normas , Tomada de Decisões , Educação de Pós-Graduação em Medicina , Inglaterra , Medicina de Família e Comunidade/educação , Geriatria/educação , Necessidades e Demandas de Serviços de Saúde , Humanos , Oncologia/educação , Corpo Clínico/educação , Corpo Clínico/psicologia , Competência Mental , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/terapia , Cuidados Paliativos/organização & administração , Seleção de Pacientes , Estatísticas não Paramétricas , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: To examine the effect of large-volume retroperitoneal germ cell tumor on nerve fibers required for erection and ejaculation. DESIGN: Retrospective case reports. SETTING: Cancer treatment center. PATIENT(S): Two male patients presenting with loss of ejaculation but preservation of erection. RESULT(S): Retroperitoneal lymph nodes lie very close to the sympathetic nerve fibers that control ejaculation. Large-volume tumors would encase the sympathetic plexuses at L1 to L3, making ejaculation impossible. Parasympathetic fibers arise from S2 to S4, so they would not be damaged, preserving erection. CONCLUSION(S): Thorough history taking is important in the investigation of infertility. Presentation with these symptoms requires further investigation at an early stage to exclude retroperitoneal tumor.