Communicating medical bad news: parents' experiences and preferences.

Parents (N = 189) of children enrolled in 15 developmental day care centers completed questionnaires that examined the experience of being told bad news and elicited preferences for physician behavior in a hypothetical situation (communicating the diagnosis of Down syndrome). Parents, in comparison with their experiences, preferred (p < 0.001) more communication of information and feelings by their physician. Their strongest preferences were for physicians to show caring (97%), to allow parents to talk (95%), and to allow parents to show their own feelings (93%). They wanted physicians to share information (90%) and to be highly confident (89%). Most parents (87%) desired parent-to-parent referral, but only a few (19%) were referred. We conclude that there is a difference between what parents experience and what they desire in physicians who communicate bad news. Physicians control the interaction and are highly confident, but parents especially value physicians who show caring and allow parents to talk and share their feelings.

Infrared thermographic measurement of circulatory compromise in trenchfoot-injured Argentine soldiers.

Passive rewarming of a cold-water stressed foot was evaluated in 33 recovered trenchfoot (TF) patients and 15 uninjured men. Infrared images were recorded prior to immersion, immediately following, and at 1-min intervals for 20 min. Individual baseline temperature (IBT) recovery was used to separate subjects into three groups designated Good and Poor Rewarming Controls (GRC and PRC) and Injured Subjects (Inj Sub). IBTs were significantly less (p less than 0.01) for Inj Sub compared to both GRC and PRC while no difference existed between GRC and PRC. This relationship changed when slopes of and areas under the mean rewarming curves were compared. Both these criteria were significantly greater (p less than 0.01) for GRC than for PRC and Inj Sub, while no difference was noted between PRC and Inj Sub. It could not be determined if the poor response of Inj Sub was inherent or a result of injury. We conclude that previously injured subjects and nearly 60% of a normal population may be at significant risk for cold injury.