Persistent vegetative state: where do we go from here?

Article Abstract:

Patients in a persistent vegetative state (PVS, a condition of permanent and complete loss of consciousness resulting from severe brain injury or disease) are really suffering from a ''new'' disease resulting from the application of modern medical technology. Although the complex ethical and legal issues surrounding this disease are often debated, PVS is rarely approached in the same manner as other diseases: as a disorder whose clinical characteristics, causes, progression, and epidemiology can be detailed. A report in the May 1991 issue of the Archives of Internal Medicine discusses the epidemiology of PVS. Patients with this disorder, who number between 5,000 and 10,000 in the United States, are generally either young people with brain injuries resulting from trauma or reduction of the flow of oxygen to the brain due to sudden low blood pressure or cardiac arrest (cessation of the heart beat), or much older people who have suffered cerebrovascular accidents (bleeding into the brain or blockage of brain vessels) or who have dementia (progressive loss of mental abilities). The study found that PVS patients are frequently hospitalized for evaluation and treatment, including surgery; questions can be raised concerning the consent process followed in such cases. The study represents a good beginning, but more research on PVS is needed. The author of this editorial believes that PVS patients suffer at some level; certainly, this must be the case if they retain any awareness of the massive extent of their disability. The author testified on behalf of a PVS patient in Massachusetts; the case (Brophy v New England Sinai Hospital) was brought to the state Supreme Court to seek withholding of nutrition and water. The Court allowed these substances to be withheld, and the patient died. It appeared that most physicians and lay people agreed with the Court's decision. Until living wills and other legal initiatives have been better developed to help PVS patients, research efforts should intensify to learn more about this devastating disorder. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Living wills, Persistent vegetative state

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Increasing frequency of staphylococcal infective endocarditis: experience at a university hospital, 1981 through 1988

Article Abstract:

Infective endocarditis, or the infection of the lining of the heart, is a serious disease with a high mortality rate. Death is usually due to heart failure, and is commonly associated with damaged heart valves. Over the last five decades, the percentage of cases of endocarditis which can be attributed to bacteria of the Staphylococcus species has steadily risen. A review of 113 cases of endocarditis from 1981 through 1988 revealed that 50 percent were caused by Staphylococcus infections. This is in contrast to 35 percent in the 1970s and 7 to 9 percent in the 1930s. The patients with staphylococcal infective endocarditis had a high mortality rate; 28 percent died, compared with 9 percent of the patients with endocarditis caused by other organisms. The mortality rates were higher for patients with congestive heart failure, atrial fibrillation, or prosthetic valve endocarditis. Patients with both congestive heart failure and Staphylococcus endocarditis had a mortality rate of 45 percent. Despite aggressive intervention with surgery and modern antibiotics, Staphylococcal endocarditis remains a serious disease with a high mortality rate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Statistics, Heart, Endocarditis, Bacterial, Bacterial endocarditis, Staphylococcal infections

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Loss of skepticism in medical education

Article Abstract:

The skill of critical thinking has been virtually eliminated from medical education. The philosophy of skepticism is basic to the scientific method and ultimately the practice of medicine. It is essential to have a skeptical attitude to the information presented in medical schools. The art of challenging answers to simple questions is currently lacking in today's medical education. Medical students are left to memorize enormous amounts of information at the cost of learning skepticism, analytical thinking and the scientific method. Medicine is taught by distributing copious amounts of handouts in large lecture halls, a process which all but eliminates small group discussions. Standardized national boards, which the medical students are required to pass, demand memorization of information, which restricts critical thinking. These board exams should be modified to condense material and set new standards in an effort to free medical education from being a hostage to the medical boards. Only then will there be a revival of critical thinking in medical education.

Analysis, Evaluation, Medical students, Education, Beliefs, opinions and attitudes, Medical education, Skepticism, Critical thinking, Medical education policy

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