D espite great technical advances in medicine, it is estimated that between 60% to 80% of all deaths will take place in the hospital [I-J]. Over the past two decades, the education of health care professionals in the area of death and dying has received considerable attention, and at the present time, most medical schools provide instruction in this area [4,5]. Little attention has been given, however, to education about death and dying during internship and residency years. ,This study was undertaken to evaluate surgical residents' attitudes, experience, and education in caring for terminally ill patients. From September 1989 to January 1990, a questionnaire concerning the care of terminally ill patients was distributed to all three general surgical residency training programs in the state of Arizona. A total of 83 questionnaires were distributed, of which 53 (64%) were returned. The questionnaire asked for certain demographic information including age, sex, and year of surgical training. The remaining questions involved three general areas: (1) experience, (2) attitude, and (3) education in caring for terminally ill patients. Junior residents (Group 1) consisted of first-and second-year residents while senior residents (Group 2) were at their third-year level of training or greater. Statistical analysis was performed using chi-square. Of the 53 surgical residents responding, there were 42 men and 11 women with a mean age of 28 years. Group 1 consisted of 25 residents and Group 2,28 residents. All housestaff questioned had cared for terminally ill patients and had discussed with a dying patient the patient's prognosis. The mean number of terminally ill patients cared for per month by each surgical resident was 2.6. Seventyfour percent of surgical residents believed strongly that patients should be told if they have a terminal illness; however, 42% of respondents believed that less than half of all terminally ill patients wish to discuss the fatality of their illness.
SUMMARYWe describe a case series involving a very unusual injury in children, i.e. a Milch 1 fracture of the lateral condyle with an associated dislocation of the elbow. This fracture configuration is normally stable as the intact capitellotrochlear groove serves as a lateral buttress for the coronoid‐olecranon ridge of the ulna. In this series, however, each patient had an associated dislocation. These injuries usually present as a clinical dislocation and if the elbow is manipulated before radiographic imaging, the fracture line can be difficult to see on the post‐reduction films. We recommend that all patients with a dislocated elbow should have elbow stability assessed under general anaesthesia, because a missed lateral condylar injury can lead to abnormalities in carrying angle, epiphyseolysis or an unstable elbow.
teeth to be extracted poses a serious risk of wrong site surgery, which is featured in the NHS Never Event List. 2 At the very least poor identification of the teeth to be extracted can result in increased expenses and delay of treatment provision, as further appointments may be needed whilst seeking clarification from the referring clinician.
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