WMJ : official publication of the State Medical Society of Wisconsin
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Chronic exposure to low levels of carbon monoxide can cause vague symptoms that are easily mistaken for other common illnesses. During the past 5 years, three families have contacted the Wisconsin Division of Public Health to report illnesses that may have been caused by chronic exposure to carbon monoxide. ⋯ Carbon monoxide exposure was not suspected as a cause of these illnesses until heating contractors discovered that gas appliances in these families' homes were not properly vented. These cases serve as reminders that carbon monoxide exposure should be considered in the differential diagnosis of patients who present with chronic symptoms of headache, fatigue, dizziness, nausea and mental confusion--especially when these symptoms onset during the winter heating season.
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Hospice is one care alternative available to the terminally ill, but if physicians do not offer this option, it is not likely to be considered by a patient who is making end-of-life decisions. A 15-item questionnaire to determine which barriers hinder or delay a physician's decision to discuss hospice with patients was sent to 147 physicians in one area of western Wisconsin. The study population included primary care physicians (family practitioners, internists and pediatricians) and specialists (cardiologists, gastroenterologists, nephrologists, neurologists, oncologists, pulmonologists, radiation oncologists, and urologists). The barriers receiving the most citations were: "patient or family hasn't accepted the terminal diagnosis," "patient or family desires to continue life-prolonging treatment," "patient has no family or friends to help hospice provide care," and "difficult to prognosticate amount of time patient has to live." Personal interviews with 13 of the participating physicians revealed additional barriers: "concern over loss of involvement with patient," "admitting patient to hospice causes some inconvenience," "deficit in physician knowledge of local hospice program," "introduction of hospice late in course of illness," and "use of home health services instead of hospice." Knowledge of these barriers may lead to an interdisciplinary approach to ensure that patients receive information of all alternatives available for terminal care.