Archives of family medicine
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The American health care reform revolution has brought about major changes in the practice of medicine. As integral components of the health care system, physicians have felt the full impact of most of these changes. ⋯ We use Kübler-Ross' grieving model to help understand physician responses to their losses inherent in health care system reform. The grieving stages of denial, anger, bargaining, depression, and acceptance are applied to these physician responses and suggestions given to help physicians through this grieving process.
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Randomized Controlled Trial Comparative Study Clinical Trial
Impact of advance directive videotape on patient comprehension and treatment preferences.
To examine the effects of an advance directive videotape on patient comprehension of advance directive concepts and preferences for resuscitation. ⋯ The advance directive videotape did not significantly affect resuscitation preferences or comprehension of selected advance directive concepts.
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To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. ⋯ Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.
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Inguinal hernias are most feared to result in incarceration and strangulation of intra-abdominal structures. Blunt abdominal blows have previously been reported to cause traumatic perforation of bowel that overlays the defect of any abdominal wall hernia. To my knowledge, this case report is the first to show that bowel perforation may be caused by direct trauma to an inguinal hernia that contains a loop of small bowel. ⋯ Then, additional pressure that is applied will raise the loop's intraluminal pressure to the point that traumatic perforation occurs. A simple experiment on a necropsy specimen showed that the proposed mechanism is plausible. This case points out another risk of leaving an inguinal hernia unrepaired.