Isr Med Assoc J
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Despite the ongoing debate on tube feeding of severely demented patients, the current approach in western countries is to avoid feeding by tube. ⋯ Tube feeding seems to have no nutritional advantage in severely demented elderly patients. Median survival was longer in tube-fed individuals who had no acute co-morbidity. However, since tube feeding does not add to patient pain and discomfort, it should not be contraindicated when it complies with the values and wishes of patients and their families.
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Nowadays more and more patients survive severe brain injury, whether due to traumatic or other causes, owing to the technological advances in medicine. Added to this is a better understanding of pathophysiologic processes, the quality and availability of emergency medicine, and increased medical knowledge in the field. ⋯ These changes in the levels of consciousness and function can also occur after very long periods of vegetative state. In our personal experience in the hospital, in 2004, 81% of patients in a post-traumatic vegetative state recovered some level of consciousness.
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The Israeli Board of Anesthesiology Examination Committee added a simulation-based Objective Structured Clinical Evaluation component to the board examination process. This addition was made in order to evaluate medical competence and considers certain domains that contribute to professionalism. This unique and new process needed to be validated. ⋯ The exam has gradually progressed from being an optional part of the oral board examination to a prerequisite component of this test. Other anesthesiology programs or medical professions can adopt the model described here.