ABSTRACT
BACKGROUND: Early childhood interventions positively contribute to health related child development. For these interventions, networks are a necessary prerequisite as they promote interdisciplinary and interprofessional cooperation. This holds especially true for the integration of health system protagonists. METHODS: In a cross-sectional survey local paediatrists, gynaecologists, general practitioners, and psychotherapists were asked about their knowledge, experiences, desires, and reservations regarding cooperation in early childhood intervention networks. RESULTS: 64 out of 1747 (3.7%) eligible clinicians answered the survey. On average they estimated that 10.1% of the families they are treating would benefit from early childhood interventions. Participants rated themselves as competent to offer appropriate early childhood interventions. The youth welfare service was judged as the most important institution for their own professional practice by 84.4%. Additionally to an applicable agenda, a fair group moderation of network meetings was seen as a substantial requirement in order to take part in network meetings. CONCLUSION: Health professionals are important protagonists in early childhood interventions. Clinicians should assess relevant problems in families and offer appropriate support on a regular basis. Alongside clearly defined regional contacts, interprofessional continuing education seems mandatory.
Subject(s)
Child Welfare , Early Medical Intervention , Education, Nonprofessional , Interdisciplinary Communication , Intersectoral Collaboration , Patient Care Team , Physicians , Psychotherapy , Adolescent , Adult , Child , Child, Preschool , Cross-Sectional Studies , Female , Germany , Health Care Surveys , Humans , Male , Middle Aged , Needs Assessment , Professional-Family Relations , Surveys and QuestionnairesABSTRACT
Interdisciplinary cooperation and networking determine the success of activities for supporting families at risk for early childhood abuse. The integration of the healthcare sector might be important.The medical standard of perinatal care at the University hospital includes information exchange about family risk factors which may contribute to an increased risk of child abuse within the first year of life. As a result, the -pediatrician offered supporting services for the families at the time of the second examination during the official childhood health screening program (U2). A team of family-sponsorship was established and evaluated.In 281 of 1238 risk-factor questionnaires at least one stress factor was detected and 97 families had high-impact family stress. Families under the supervision of a family midwife or youth services had a significantly higher number of risk factors. The family-sponsorship program was institutionalized and positively evaluated by the families.The time of a hospital delivery is an excellent opportunity for the evaluation of familial risk factors and for the provision of supporting services. To increase the acceptance of such services by the families at risk repeated assessment of risk factors and support offers are required.
Subject(s)
Child Abuse/prevention & control , Cooperative Behavior , Early Medical Intervention , Health Services Accessibility , Interdisciplinary Communication , Child Abuse/diagnosis , Early Diagnosis , Female , Germany , Humans , Infant , Infant, Newborn , Life Change Events , Male , Mass Screening , Patient Care Team , Risk Factors , Surveys and QuestionnairesABSTRACT
Medical child protection includes besides interdisciplinary diagnostics and treatment of physical and psychological symptoms also a discussion that looks at the ensuing legal consequences.This study analyses 21 criminally investigated cases of suspected child abuse from a 2 year study period and compares severity of injury to legal outcome.7 of those 21 criminal proceedings were already dropped by the prosecution and never went to trial. 4 of the 8 cases that led to a trial ended with a conviction. In all of the 4 cases that resulted in an acquittal the judges had been convinced that the child had been abused but found themselves unable to exactly identify the perpetrator. Our study's cases did not show a positive correlation between severity of injury and legal outcome.Diagnosing and treating children and minors within the context of medical child protection should always also include the ques-tion of possible legal consequences. The judicial process in cases of serious child abuse requires high medical expertise. Such expertise particularly includes the ability to determine the time of injury as exactly as possible and to provide precise written documentation of any medical findings. However, our study also shows that medical assessment is only one of many aspects in the legal response to child abuse.
Subject(s)
Child Abuse/legislation & jurisprudence , Child Welfare/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Mandatory Reporting , Wounds and Injuries/diagnosis , Accidents/legislation & jurisprudence , Adolescent , Child , Child Abuse/diagnosis , Child Abuse/therapy , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/legislation & jurisprudence , Child Abuse, Sexual/therapy , Child, Preschool , Cooperative Behavior , Female , Germany , Humans , Infant , Injury Severity Score , Interdisciplinary Communication , Liability, Legal , Male , Retrospective Studies , Statistics as Topic , Wounds and Injuries/classification , Wounds and Injuries/therapyABSTRACT
A sensitive and simple liquid chromatography/mass spectrometry (LC/MS) method was developed for the determination of terephthalic acid isopropylamide, the final metabolite of procarbazine in human urine. A solid-phase extraction with C(18) cartridges was used followed by LC/MS with a single mass spectrometer (SSQ 7000 from Finnigan). Terephthalic acid isobutylamide was the internal standard. The quantification limit was 30 ng/mL in urine (6 x noise). This assay was applied for drug monitoring of terephthalic acid isopropylamide in urine after oral administration of procarbazine in children and adolescents with Hodgkin lymphomas.
Subject(s)
Chromatography, Liquid/methods , Mass Spectrometry/methods , Phthalic Acids/urine , Adolescent , Drug Monitoring , Drug Stability , Female , Humans , Kinetics , Male , Phthalic Acids/chemistry , Procarbazine/administration & dosage , Procarbazine/chemistry , Procarbazine/metabolism , Procarbazine/pharmacologyABSTRACT
BACKGROUND: The focused abdominal sonogram for trauma (FAST) has been used by surgeons and emergency physicians (CLIN) to screen reliably for hemoperitoneum after trauma. Despite recommendations for "appropriate training," ranging from 50 to 400 proctored examinations, there are no supporting data. METHODS: We prospectively examined the initial FAST experience of CLIN in detecting hemoperitoneum by using diagnostic peritoneal lavage, computed tomography, and clinical findings as the diagnostic "gold standard." RESULTS: 241 patients had FAST performed by 12 CLIN (average, 20/CLIN; range, 2-43); 51 patients (21.2%) had hemoperitoneum and 17 patients (7.1%) required laparotomy. Initial experience with FAST by CLIN produced 35 true positives, 180 true negatives, 16 false negatives, and 3 false positives; sensitivity, 68%; specificity, 98%. Initial error rate was 17%, which fell to 5% after 10 examinations (chi2; p < 0.05). CONCLUSION: Previous recommendations for the number of proctored examinations for individual nonradiologist clinician sonographers to develop competence are excessive.
Subject(s)
Abdominal Injuries/diagnostic imaging , Hemoperitoneum/diagnostic imaging , Radiology/education , Ultrasonography/standards , Wounds, Nonpenetrating/diagnostic imaging , Abdominal Injuries/diagnosis , Adult , Diagnostic Errors/statistics & numerical data , Emergency Medicine/education , Female , Humans , Injury Severity Score , Learning , Male , Peritoneal Lavage , Prospective Studies , Sensitivity and Specificity , Tomography, X-Ray Computed , Vermont , Wounds, Nonpenetrating/classificationABSTRACT
Between 1963 and 1971 47 Patients with not resectable duodenal ulcer who underwent this type of operation were followed up. The complication rate was low, the long term results were good.
