ABSTRACT
OBJECTIVES: To evaluate congenital syphilis surveillance in Minnesota, to assess the evaluation and management of newborns at risk for congenital syphilis, and to assess prenatal syphilis screening. DESIGN: Case ascertainment and medical record review. SETTING: The 7-county Minneapolis-St Paul metropolitan area. PATIENTS: Newborns at risk for congenital syphilis during a 3-year period (1992-1994). MAIN OUTCOME MEASURES: The completeness of congenital syphilis case ascertainment, maternal demographic data, maternal syphilis management, newborn evaluation for and management of congenital syphilis, and hospital syphilis screening practices at delivery. RESULTS: Eighty mother-infant pairs who were at risk for congenital syphilis were identified from 3 sources. Using the Centers for Disease Control and Prevention's congenital syphilis case definition, 36 infants (45%) were classified as probable cases, 42 (53%) were classified as noncases, and 2 (3%) were syphilitic stillbirths. Forty-seven women (59%) had syphilis serologic tests performed in the third trimester; only 37 (46%) had syphilis screening at delivery. Conditions of the mothers of 8 probable cases (22%) were diagnosed at delivery. Most probable cases (86%) were evaluated; only 56% were evaluated adequately. Twenty-five probable cases (69%) were treated. Most hospitals did not have formal policies for syphilis screening at delivery. The Minnesota Department of Health's congenital syphilis registry lacked sensitivity (39%) as a case ascertainment method. CONCLUSIONS: Clinicians should adhere to standardized protocols in the evaluation and management of at-risk newborns. Vigilant screening prenatally and at delivery and adequate follow-up are critical to reduce congenital syphilis. Improved surveillance data and resources are needed for the identification and follow-up of newborns at risk for congenital syphilis.
Subject(s)
Neonatal Screening , Population Surveillance , Syphilis, Congenital/epidemiology , Adolescent , Adult , Female , Humans , Infant, Newborn , Male , Minnesota/epidemiology , Pregnancy , Pregnancy Complications, Infectious/ethnology , Prenatal Care , Risk Factors , Sensitivity and Specificity , Syphilis/ethnology , Syphilis, Congenital/diagnosis , Syphilis, Congenital/ethnologyABSTRACT
Caring for survivors of victimization is very hard work, in ways that are similar to and different from other difficult patient interactions. Careful attention to basic physiologic and psychological needs of the physicians is necessary to tolerate the stress and to prevent the burnout that can accompany this work. In addition, understanding survivors' interpersonal dynamics may help physicians provide better care. Consultation with colleagues is essential to remaining healthy and effective as givers of care.
Subject(s)
Adaptation, Psychological , Burnout, Professional/psychology , Child Abuse/complications , Physicians, Family/psychology , Stress Disorders, Post-Traumatic/therapy , Violence , Adult , Burnout, Professional/prevention & control , Child , Chronic Disease , Countertransference , Defense Mechanisms , Female , Gender Identity , Humans , Male , Physician-Patient Relations , Power, Psychological , Role , Self Care , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Post-Traumatic/etiologyABSTRACT
Conceptualizing medical education as a family system facilitates recognition of the dynamics within the system which perpetuate many of the problems facing teachers, students, and practicing physicians. Neglectful and abusive families are often characterized by their unrealistic expectations, denial, indirect communication patterns, rigidity, and isolation. The medical education system has similar patterns of behavior that contribute to problems at all levels of the training process and include practicing physicians. The communication patterns within the teaching hospital reinforce trainees' strivings for perfectionism and devalue the contributions of nonphysician staff to the supervision of the physician-in-training. Excluding the potentially healing influence of "outsiders" contributes to the rigidity within the system. Like parents who raise their children as they themselves were raised, each generation teaches as they were taught, and the patterns are loyally perpetuated. Teachers will need to address their own training experiences, acknowledging the dysfunctional behavior patterns learned and the pain those behaviors cause. Then educators can begin to change how they teach and break the cycle of physical neglect and emotional abuse that has been inherited.
Subject(s)
Education, Medical/standards , Family Therapy , Interpersonal Relations , Communication , Education, Medical/trends , Humanism , Humans , Organizational Culture , Role , Set, Psychology , Social IsolationABSTRACT
Nine hundred ninety-seven breast biopsies that were performed at one hospital over the five-year period from 1971 through 1975 were reviewed because of a changing pattern in the use of breast biopsies on outpatients who were under local anesthesia. In 1971, 17% of all breast biopsies were performed as outpatient procedures; by 1975, the figure was 60%. In 1971, 5% of all malignant neoplasms were diagnosed by the use of biopsies as outpatient procedures and 30% in 1975. Hospital charges for biopsy on an inpatient basis of benign breast disease were 7.2 times higher than for biopsy on an outpatient basis. Interviews of 102 patients clearly suggested that most patients were satisfied with the outpatient breast biopsy experience. Outpatient breast biopsy under local anesthesia is a safe procedure that is more economical in terms of medical cost, surgeons' time, and patients' time away from home and/or job. Preliminary biopsy of malignant lesions using local anesthesia permits more efficient use of diagnostic procedures to stage the extent of disease prior to treatment. Patient acceptance of breast biopsy as an outpatient procedure under local anesthesia was similar to their acceptance of biopsy on an inpatient basis under general anesthesia.
