WMJ : official publication of the State Medical Society of Wisconsin
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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.
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Comparative Study
Shotgun wound management: a comparison of slug and pellet injuries.
Shotgun slug injuries have received little attention while shotgun pellet wounds have been well described. Twenty-two shotgun pellet and 13 shotgun slug injuries treated over a 14-year period were retrospectively reviewed. Extremity and thoracic wounds were most frequent in both groups. ⋯ Tissue grafting was more frequently necessary for reconstruction after pellet injury. Long-term disability was documented in 15% of patients with pellet wounds and 23% with slug wounds. Despite similarities in wound location and outcomes, the ballistic differences between shotgun slugs and pellets resulted in significant differences in wounding characteristics and extent of injury which have important ramifications in management.
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Stadium crowd surges frequently occur following major athletic events. A recent crowd surge injured more than 80 persons by trampling and/or crushing. This incident was reviewed to identify injury patterns consistent with crush-related injury. In addition, the incident was reviewed to determine which stadium policy and design factors may have potentiated this event. ⋯ This report details the largest single report of traumatic asphyxia second to the England Hillsborough disaster. Several stadium factors were identified that resulted in crush-related injury. Cooperative review and modification of stadium policies and design may prevent such events in the future.