BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals retrospectively from (...) January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

« Il faudrait écrire un autre livre pour pouvoir consacrer à ces dossiers toute l'attention qu'il mérite » écrit J.P. Albert dans sa conclusion. Son ouvrage dense, vigoureux, foisonnant d'avancées prometteuses se restreint, en effet, difficilement à l'étude des voies singulières de la sanctification des femmes dans le christianisme romain et le lecteur de subodorer que cette recherche passionnée et passionnante risque fort de déboucher sur deux autres publications, l'une consacrée à un...

[1]. Nonmun p'yŏn -- [2-3]. Charyo p'yŏn, 1-2.

1-2. Charyo p'yŏn, 1-2 -- [3]. Nonmun p'yŏn.

The paper studies the nature of understanding in condensed matter physics (CMP), mediated by the successful employment of its models. I first consider two obvious candidates for the criteria of model-based understanding, Van Fraassen's sense of empirical adequacy and Hacking's instrumental utility , and conclude that both are unsatisfactory. Inspired by Hasok Chang's recent proposal to reformulate realism as the pursuit of ontological plausibility in our system of knowledge, we may require the model under consideration to be understood (or intelligible) (...) before claiming model-based understanding. Here the understanding of a model typically consists of the following: figuring out at least one plausible (preferably realistic) physical mechanism for the model, determining the theoretical consequences of the model by mathematically probing it and developing our physical intuitions about the model. I consider the q-state Potts model to illustrate. After having understood a model, we may employ the model to understand its target phenomena in the world. This is done by matching one of the interpretative models of the model with the central features of the phenomena. The matching should be motivated (ideally both theoretically and empirically) in the sense that we have good reason to believe that the central features of the phenomena can be thought of as having more or less the same structure as postulated by the interpretative model. In conclusion, I propose a two-stage account of model-based understanding in CMP: (1) understanding of a model and (2) matching a target phenomenon with a well-motivated interpretative model of the model. Empirical success and instrumental utility both play their roles in the evaluation of how successful the model is, but are not the essential part of model-based understanding. (shrink)

Lawrence Sklar in his book, Physics and Chance (1993), proposes a sophisticated account of reduction of thermodynamics (TD) by statistical mechanics (SM). I argue that Sklar's analysis of the alleged reduction of TD by SM is problematic in several respects. I consider a few counterexamples to show that none of what Sklar takes to be the central features of successful reduction in science (unification and identification) holds in the case of TD and SM. I suggest the broader conclusion that a (...) more useful way of understanding the relationship between TD and SM is as collaboration and competition among alternative methodologies rather than reduction of one theory to another. (shrink)

This paper aims: (1) to show that Lawrence Sklar`s recent attempt to reduce thermodynamics(TD) to statistical mechanics(SM) is fallacious in several respects; and (2) to suggest a broader conclusion that a more useful way of understanding the relationship between TD and SM is as collaboration and competition among alternative methodologies rather than reduction of one theory to another. To argue for (1), I discuss two cases (the distinction of intensive/extensive variables in TD and the existence of phase transitions) where TD (...) is more accurate than statistical mechnaics and thus corrects SM. I also discuss the case of temperature in order to argue for both (1) and (2). (shrink)