ABSTRACT
OBJECTIVES: To describe misperceptions of sexual abuse by critically ill, sedated patients undergoing routine perineal care in an intensive care unit and to offer suggestions for addressing patient allegations of sexual mistreatment in this setting. DESIGN: Case reports and discussion. SETTING: Intermediate care unit extension of a medical intensive care unit at a university teaching hospital. PATIENTS: A 57-yr-old man who misperceived rectal intubation as sexual assault while receiving intravenous lorazepam for sedation; a 31-yr-old woman who misinterpreted a perineal bed bath as sexual abuse while receiving lorazepam and fentanyl. INTERVENTIONS: None. CONCLUSIONS: Under the influence of commonly used psychotropic drugs, some acutely ill, hospitalized patients misperceive routine perineal care as sexual abuse. Because the care that gives rise to mistaken allegations of sexual misconduct is often given in private, and because sexual abuse of patients sometimes actually occurs in hospitals, institutional investigation of these complaints is both sensitive and difficult. Some inpatient allegations of sexual abuse may not be resolvable by any means. Awareness of the potential for misinterpretation of perineal care may help prevent this disturbing phenomenon and promote fair, reasoned investigation when patient complaints of sexual abuse do arise in acute care hospitals.
Subject(s)
Critical Care/psychology , Deception , Professional-Patient Relations , Sexual Behavior , Adult , Critical Care/methods , Female , Hospitals, University , Humans , Male , Middle AgedABSTRACT
The complete exonic and partial intronic sequence of the bovine CYP17 (P45017 alpha) gene has been determined. The gene contains eight exons with exon/intron boundaries which are identical to those determined previously for the human CYP17 gene. The site of initiation of transcription of this gene is located within a 6-base sequence 52 bp from the initiation of translation. Considerable sequence homology (58.7%) is found when approximately 500 bp of the 5'-flanking sequences of the bovine and human CYP17 genes are compared. A computer-based search of this region of bovine CYP17 for consensus sequences associated with binding of transcription factors (i.e., GR, PR, CREB/ATF, AP1, AP2, AP3, AP4, AP5, OTF, CTF/NF1, SP1) shows only the consensus CREB/ATF sequence TGACGT which is also found to be at approximately the same position in the human CYP17 gene. In bovine adrenal cortex, transcription of the CYP17 gene is regulated by the peptide hormone adrenocorticotropin via cAMP. Whether the consensus CREB/ATF sequence is associated with the cAMP-mediated transcription of the CYP17 gene remains to be elucidated.
