The objective of this survey was to assess the extent to which nurses encounter and identify dilemma-generating situations in the light of the publication and circulation of the Israeli code of ethics for nurses in 1994. The results are being used as a basis for a programme aimed at promoting nurses' decision-making skills in coping with ethical dilemmas. In this era of major advances in medicine, the nurse's role as the protector of patient rights may bring about conflicts with physicians' orders, with institutional policies, or with patients' families. Nurses will then become confronted with ethical and moral dilemmas. A nationwide survey was carried out to identify and describe the ethical conflicts with which nurses in Israel are confronted in the course of their work. A third of the enumerated dilemmas were encountered by more than 50% of the nurses. The major determinant influencing encounters with dilemmas, as perceived by the participating nurses, was their work setting, namely, the hospital versus the community. It was shown that nurses seek support mainly among their peers, they are barely familiar with the Israeli Code, and they consider their own families as the predominant factor in shaping their ethical attitudes.
SummaryThe rates of consanguinity among the parents of babies born in Israel during 1955‐57 were estimated by screening the maternity wards. First‐cousin marriages ranged between 1 and 2 % in Ashkenazic Jews, while the majority of the other Jewish communities exhibited far higher rates of consanguinity.There is little basis for the assumption that the incidence of cousin marriages in Jewish groups reflects the sizes of the isolates in the diaspora. The non‐randomness of such unions finds expression in the distinct preference for marriages between the children of like‐sexed sibs.Cousin marriages between persons originating from different countries testify to some amount of gene flow, which occurred in the recent past between the different groups in the diaspora.Among several ethnic groups, the marriages concluded after immigration to Israel exhibit a trend towards declining consanguinity rates. While this tendency might merely indicate the break‐up of the smaller isolates, which have hitherto existed within the communities, a process of merging between these larger units has also set in on a very large scale. Ashkenazic Jews originating from different countries intermarry at an increasing rate. At present only a minority of persons belonging to the smaller Ashkenazic groups choose partners of identical origin. Around 10 % of Ashkenazic Jews contract marriages with members of the other communities. Intercommunity marriages between the various non‐Ashkenazic congregations are also very common.A rough estimate of the genetic risk involved in consanguineous unions was obtained by comparing the mean numbers of live children after different durations of marriage in cousin families and others. In two out of five such comparisons, the cousin families exhibited a small but significant disadvantage. However, no difference in family size could be detected between mothers, who are offspring of first cousins and all other mothers in the sample.We are greatly indebted to Dr Shaul Merin, who participated in some of the field work during this survey. In the sorting and evaluation of the data we were assisted by Fredy Gruber, Sarah Rapaport, Navah Bloch and Elisheva Barak.It is a pleasure to acknowledge the courtesy and co‐operation of the medical authorities and the nursing staff of the following maternity wards: Rambam Government Hospital, Haifa; Rothschild Municipal Hospital, Haifa; Hadassah Municipal Hospital, Hakirya, Tel‐Aviv; Governmental Hospital, Tsahalon Division, Jaffa, T.A.; Beilinson Hospital, Petah‐Tiqwa; Hadassah University Hospital, Jerusalem; Bikur Holim General Hospital, Jerusalem; Shaarei Tzedek, General Hospital, Jerusalem.We are also much obliged to Prof. R. Bachi, Director of the Central Bureau of Statistics, Government of Israel, for consultations and references.
The computerized laboratory database is useful in ascertaining the prevalence of severe hypokalemia and in assessing shortcomings in its management. Databases can be used to derive valid and efficient measures of the quality of the clinical management of electrolyte disorders.
Ethnicity has been described as a prognostic factor in breast cancer and in childhood acute lymphocytic leukemia but not in adult acute myeloid leukemia (AML). We reviewed the records of 225 consecutive AML patients who were diagnosed and treated between 1983 and 1995. Data were collected concerning demographic factors, presenting clinical features, and treatment protocols. We categorized ethnicity as follows: European Jews, non-European Jews, and Arabs. We assessed the role of ethnicity controlling for other known prognostic factors on treatment outcome and survival in this population. Older age, high leukocyte count at diagnosis, and high-risk chromosomal aberrations were significantly associated with overall survival in univariate analysis. In multivariate analysis high leukocyte count and high-risk chromosomal aberrations exerted an independent negative effect on survival. European origin was associated with longer event-free survival in univariate analysis (P = 0.024) and longer overall (P < 0.01) and event-free (P < 0.01) survival but not with a higher remission rate in multivariate analysis. For AML patients who achieved remission after induction chemotherapy and survived its complications, European origin is an independent favorable prognostic factor for long-term remission and survival in Israel. These findings may reflect better socioeconomic status, social support, increased compliance with treatment protocols, or better psychological coping mechanisms with malignancy. Am. J. Hematol. 72:127-134, 2003.
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