PubMed · 7774274
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B B Gray. 1995. What heals? What do nurses do that makes a difference?. https://pubmed.ncbi.nlm.nih.gov/7774274/
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BACKGROUND: Forty-one million Americans have no health insurance and, despite the growth of managed care, medical costs are again increasing rapidly. One proposed solution is a single-payer health care financing system with universal coverage. Yet, physicians' views of such a system have not been well studied. METHODS: We surveyed a random sample of physicians (from the American Medical Association Masterfile) in Massachusetts, regarding their views on a single-payer health care financing system and other financing and physician work-life issues that such a system might affect. RESULTS: Of 1787 physicians, 904 (50.6%) responded to our survey. When asked which structure would provide the best care for the most people for a fixed amount of money, 63.5% of physicians chose a single-payer system; 10.7%, managed care; and 25.8%, a fee-for-service system. Only 51.9% believed that most physician colleagues would support a single-payer system. Most respondents would give up income to reduce paperwork, agree that it is government's responsibility to ensure the provision of medical care, believe that insurance firms should not play a major role in health care delivery, and would prefer to work under a salary system. CONCLUSIONS: Most physicians in Massachusetts, a state with a high managed care penetration, believe that single-payer financing of health care with universal coverage would provide the best care for the most people, compared with a managed care or fee-for-service system. Physicians' advocacy of single-payer national health insurance could catalyze a renewed push for its adoption.
OBJECT: The aim of this work is to analyze the current management of hydrocephalus associated with posterior fossa (PF) tumors. METHODS: The personal perspectives of experienced pediatric neurosurgeons were presented at a virtual round table. DISCUSSION: Preoperative hydrocephalus has been reported in about 80% of patients with PF tumors and postoperative treatment is required for persistent or progressive hydrocephalus in about 25-30% of the cases. Preoperative management includes external ventricular drainage (EVD), endoscopic third ventriculostomy (ETV), shunt insertion, and no treatment at all, while ETV and ventriculo-peritoneal (V-P) shunt are recommended as treatment after PF craniotomy. CONCLUSION: There is no consensus on the way hydrocephalus should be managed before, during, and after PF surgery. While awaiting prospective multicenter trials of various management schemes the perioperative management of hydrocephalus in the context of posterior fossa tumors should be considered as options.
In every medical specialty bad, sad, and difficult information must be given to patients and their families. An insensitive approach increases the distress of recipients of bad news, may exert a lasting impact on their ability to adapt and adjust, and can lead to anger and an increased risk of litigation. Many doctors also find these interactions stressful, and in the absence of much effective training they may adopt inappropriate ways of delivering bad news and coping with the emotional fall-out. Recognition of these difficulties has led to many initiatives, ranging from increased communication skills training to the development of guidelines and protocols. We review some of the research on the impact that giving sad, bad, and difficult news has on doctors and patients, and assess whether interventions are helping. We focus mainly on difficulties encountered involving parents in an obstetric or paediatric setting, people in acute trauma situations such as accident and emergency departments, and patients with cancer.