Reorganization and quality management of psychiatric and substance abuse patients.

We conducted a study in the mental health and behavioral sciences program at Hines Veterans Administration Hospital to determine if a recent reorganization of the mental health services had resulted in the efficient use of treatment resources according to patients' needs. The Brief Symptom Inventory was used to assess symptomatology when patients were admitted to the inpatient psychiatry, dual diagnosis, or substance abuse lodger units. The results indicated that the groups differ significantly from one another on eight of nine symptom dimensions and on all three global indices of psychopathology.

Ethical considerations in treating oncology patients in the intensive care unit.

The care of oncology patients within an intensive care unit (ICU) setting poses an added dimension of ethical concerns faced by practitioners. This article reviews/highlights some of the issues confronting ICU staff when caring for an oncology patient. The issues addressed include: access/admission of the oncology patient to the ICU, advance directives, and the withdrawal of life-sustaining treatments.

Decisions not to transplant: futility or rationing.

Since the 1980s, heart transplantation has become an acceptable treatment therapy for patients with end-stage congestive heart failure. In recent years, the demand for heart transplantation has exceeded the supply of available organs. Potential transplant candidates undergo rigorous screening to determine which patients will be offered transplantation as a treatment option.

Cardiac retransplantation: determining limits.

Objective: Cardiac transplantation has become an acceptable treatment option for end-stage congestive heart failure. Because of the increasing demand, there are not enough hearts to supply all patients in need of cardiac transplantation. This significant supply and demand imbalance necessitates that rationing decisions be made.