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Background Decisions of withholding or withdrawing life sustaining-treatments in emergency department are part of current practice but the decision-making process remains poorly described in the literature. Study objective We conducted a study in two phases, the first comprising a retrospective chart review study of patients dying in the ED and the second comprising survey study of health care workers at 10 urban emergency departments in France. Method In a first step, we analyzed medical records based on fifteen criteria of the decision-making process grouped into four categories: the collegiality, the traceability, the management and the communication as recommended by the international guidelines. In a second step, we conducted an auto-administrated survey to assess how the staff members (medical, paramedical) feel with the decision-making process. Results There were 273 deaths which occurred in the ED over the study period and we included 145 (53.1%) patients. The first-step analysis revealed that the traceability of the decision and the information given to patient or the relatives were the most reported points according to the recommendations. Three of the ten emergency departments had developed a written procedure. The collegial discussion and the traceability of the prognosis assessment were significantly increased in emergency department with a written procedure as well as management of pain, comfort care, and the communication with the patient or the relatives. In the second-step analysis, among the 735 staff members asked to take part in the survey, 287 (39.0%) answered. The medical and paramedical staff expressed difficult experience regarding the announcement and the communication with the patient and the relatives. Conclusion The management of the decision to withhold or withdraw life-sustaining treatments must be improved in emergency departments according to the guidelines. A standard written procedure could be useful in clinical practice despite the lack of experienced difference between centers with and without procedures.

The extracts of plants have raised benefit as sources of natural products. They have been examined for their potential uses as alternative solution for the treatment of many infectious diseases. To this end, the present study examines the phytochemical screening, an oxidant and an bacterial properties of crude aqueous, ethyl acetate and methanolic extracts of Ammodaucus leucotrichus Coss. & Dur. seeds growing spontaneously in the Wilaya of Bechar. Phytochemical invesyigation was carried out to determine the possible bioactive components in the extracts of plant . The total phenol content and avonoids were also determined for all extracts. The an oxidant ac vi es were es mated by DPPH scavenging method compared to the ascorbic acid an oxidant. The methanolic extract showed a good scavenging ac vity comparable to ascorbic acid, with an IC50 value of 0.10±0.14 mg/l. An bacterial activity was tested against seven pathogenic strains by using Disc diffusion method and agar dilution method. Among the extracts tested, methanolic extract showed significant an bacterial activity against bacteria with MIC between 0.95 to 6.02 mg/ml. These results are promising and provide scientific that this species can be used as good an oxidant and an bacterial agents.

Background: The presence of antioxidants such as polyphenol, in plants may provide protection against a number of diseases. Moreover, pathogenic fungi can cause a variety of adverse health effects and pose a serious health threat to both humans and livestock. The aim of present study was to determine the antioxidant and antifungal activities of aerial part extracts from Ephedra alata Decne. Methods: Antifungal activities were tested against three pathogens fungi using mycelial growth, sporulation and germination spores. Result: The determination of the polyphenol contents, total flavonoids and condensed tannins of the aerial part extracts gave respectively (TPC: 40.45±0.18 mg GAE/g, TFC: 133.25±0.11 mg QE/g, TCT: 20.76±0.19 mg CE/g). The flavonoids and methanolic extracts showed a good scavenging activity with an IC50: 0.23±0.66; 0.54±0.35 mg/ml, respectively. For antifungal properties, flavonoids extract showed the inhibitoriest activity against fungi tested, followed by methanolic extract.