BACKGROUND: With the passage of the Patient Self-Determination Act in 1990, new procedures and documents became available for planning end-of-life care. These new procedures and documents are now being examined scientifically. OBJECTIVE: To review existing research on the use of advance directives. DATA SOURCES: Computer search using Grateful Med software from the National Library of Medicine with MEDLINE and BIOETHICSLINE databases. STUDY SELECTION: Studies that showed an emerging consensus or reported vastly differing results were selected. Selected studies examined these specific areas: demographic data on patients with advance directives, completion rates, capacity to complete, patients' preferences, stability of patients' decisions over time, treatment choices, proxy decision makers, treatment provided, and cost. RESULTS: The body of important research about advance directives is growing. A profile of their clinical utility is emerging. CONCLUSIONS: The research done so far can stimulate future research and can begin to suggest possible changes in practice. However, the body of research is not yet large enough or well controlled enough to answer conclusively many of the questions about planning of end-of-life care.
BACKGROUND: Lung volume reduction surgery is currently being investigated as a method of improving the respiratory function of patients with end-stage emphysema. PURPOSE: This article reviews the current literature on lung volume reduction surgery and proposes a multidisciplinary team approach to postoperative management. METHODS: We did a MEDLINE search and retrieved relevant articles. We selected and reviewed nine medical articles published in 1993, 1995, and 1996; one medical article from 1959; and one of four nursing articles. Overall, the articles describe the different techniques of median sternotomy and video-assisted thoracoscopic surgery and unilateral versus bilateral procedures. CONCLUSION: Lung volume reduction surgery is beneficial, but further investigation is required.
The definition of death, brain death in particular, is increasingly important to critical care professionals. There are essentially three definitions of death from a theoretical perspective: the traditional heart-lung definition, the whole-brain definition, and the higher-brain definition. These definitions use different underlying assumptions within their own theoretical framework. The differing definitions and theoretical frameworks have encouraged physiological, philosophical, spiritual, and ethical analyses, which have led to spirited debate throughout the healthcare community and especially in critical care.