Association between education in EOL care and variability in EOL practice: a survey of ICU physicians

This study investigated the association between physician education in EOL and variability in EOL practice, as well as the differences between beliefs and practices regarding EOL in the ICU. Physicians from 11 ICUs at a university hospital completed a survey presenting a patient in a vegetative state with no family or advance directives. Questions addressed approaches to EOL care, as well physicians' personal, professional and EOL educational characteristics. The response rate was 89%, with 105 questionnaires analyzed. Mean age was 38 +/- A 8 years, with a mean of 14 +/- A 7 years since graduation. Physicians who did not apply do-not-resuscitate (DNR) orders were less likely to have attended EOL classes than those who applied written DNR orders [0/7 vs. 31/47, OR = 0.549 (0.356-0.848), P = 0.001]. Physicians who involved nurses in the decision-making process were more likely to be ICU specialists [17/22 vs. 46/83, OR = 4.1959 (1.271-13.845), P = 0.013] than physicians who made such decisions among themselves or referred to ethical or judicial committees. Physicians who would apply "full code" had less often read about EOL [3/22 vs. 11/20, OR = 0.0939 (0.012-0.710), P = 0.012] and had less interest in discussing EOL [17/22 vs. 20/20, OR = 0.210 (0.122-0.361), P < 0.001], than physicians who would withdraw life-sustaining therapies. Forty-four percent of respondents would not do what they believed was best for their patient, with 98% of them believing a less aggressive attitude preferable. Legal concerns were the leading cause for this dichotomy. Physician education about EOL is associated with variability in EOL decisions in the ICU. Moreover, actual practice may differ from what physicians believe is best for the patient.

'Syrah' vine on different rootstocks in winter cycle in the south of Minas Gerais State, Brazil

The objective of this work was to evaluate rootstock influence on agronomical, ecophysiological and qualitative characteristics of 'Syrah' vines managed by double pruning. Grapevines were grafted onto 'SO4', '110 Richter' and '1103 Paulsen' rootstocks and trained in vertical shoot position, with no irrigation. Ecophysiological characteristics, yield and composition of ripe grapes were evaluated in three crop seasons (2007, 2008 and 2010). Rootstocks did not affect pre-dawn water potential, with values close to -0.2 MPa, indicating that there was no soil water deficit at the end of ripening (June). There was also no significant effect of rootstocks on yield. The rootstock '1103 Paulsen' induced lower vegetative growth, lower photosynthetic rate and the best results for berry maturation for crop seasons with lower amount of rainfall. The rootstocks '110 Richter' and 'SO4' showed higher vigor under the meteorological conditions of 2010 and the greatest photosynthetic rates in the same period. Meteorological conditions significantly affected technological and phenolic ripeness, with best results observed in drought years. The '1103 Paulsen' rootstock provides better balance between vigor and yield, increasing grape quality.