A child whose parent insists on recurrent medical admissions

2021 ◽  
pp. 167-174
Author(s):  
Lauren N. Deaver
Keyword(s):  
Child Abuse ◽  
High Risk ◽  
Medical Care ◽  
Warning Signs ◽  
Factitious Disorder ◽  
Specialty Training ◽  
Detailed Review ◽  
Medical Child Abuse ◽  
Atypical Presentations ◽  
Abuse Treatment

Factitious disorder imposed on another (FDIA) occurs when a caregiver deliberately falsifies illness in a child despite the absence of obvious external rewards. The caregiver receives the diagnosis of FDIA and the child is a victim of medical child abuse. Factitious disorder imposed on another is associated with a high risk of morbidity and mortality. Warning signs that raise concern for FDIA include atypical presentations, multiple illnesses, seeking care from multiple providers, resisting reassurances that the child is healthy, and testing/observations that are inconsistent with the caregiver’s report. The assessment should include a detailed review of reported signs/symptoms as well as objective findings in the patient’s medical record. All physicians involved in the child’s care should come to a consensus regarding ongoing management, and it may be helpful to consult with a pediatrician with specialty training in child abuse. Treatment includes ensuring the child’s safety, discontinuing unnecessary medical care, and providing psychotherapy.

scholarly journals 451. Evaluation of Exposure History in Healthcare Personnel with Coronavirus 2019 Disease

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S293-S293
Author(s):  
Sandra Silva ◽  
Thriveen Mana ◽  
Davinder Bhullar ◽  
Beatrice Tabor ◽  
Curtis Donskey
Keyword(s):  
High Risk ◽  
Risk Exposure ◽  
Healthcare Personnel ◽  
Administrative Personnel ◽  
Asymptomatic Carriage ◽  
Moderate Disease ◽  
Control And Prevention ◽  
History Of ◽  
Exposure History ◽  
Atypical Presentations

Abstract Background During the Coronavirus Disease 2019 (COVID-19) pandemic, many healthcare personnel (HCP) have developed COVID-19. However, there is uncertainty regarding whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was acquired at work versus in the community. Methods We conducted a cohort study to examine exposure history of personnel with COVID-19 infection or asymptomatic carriage in a VA healthcare system. High-risk exposures were classified based Centers for Disease Control and Prevention criteria. Results Of 578 personnel tested, 49 (8%) had nasopharyngeal swabs with positive PCR results, including 45 (92%) with and 4 (8%) without COVID-19 symptoms. Of the 49 cases, 21 (43%) had a documented high-risk exposure at work, including 14 exposures to COVID-19 patients and 7 exposures to colonized or infected personnel. Exposures to infected patients most often were a result of delays in recognition of COVID-19 due to atypical presentations. Exposures to personnel with COVID-19 most often involved activities such as meals when facemasks were not worn. Most cases occurred among nurses (26, 53%) and administrative personnel (10, 20%); only 3 physicians developed COVID-19. No cases occurred in personnel working on COVID-19 wards. All personnel had mild or moderate disease. Conclusion Forty-three percent of healthcare personnel with COVID-19 had prior high-risk exposures at work. Improved detection of patients with atypical presentations and efforts to reduce high-risk contacts among personnel may reduce the risk for acquisition of SARS-CoV-2. Disclosures All Authors: No reported disclosures

scholarly journals Multidisciplinary Unit Improves Pregnancy Outcomes in Women with Rheumatic Diseases and Hereditary Thrombophilias: An Observational Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1487
Author(s):  
Isabel Añón-Oñate ◽  
Rafael Cáliz-Cáliz ◽  
Carmen Rosa-Garrido ◽  
María José Pérez-Galán ◽  
Susana Quirosa-Flores ◽  
...  
Keyword(s):  
High Risk ◽  
Observational Study ◽  
Medical Care ◽  
Pregnant Women ◽  
Rheumatic Diseases ◽  
Absolute Risk ◽  
University Hospital ◽  
Obstetric Outcomes ◽  
Number Needed To Treat ◽  
Foetal Death

Rheumatic diseases (RD) and hereditary thrombophilias (HT) can be associated with high-risk pregnancies. This study describes obstetric outcomes after receiving medical care at a multidisciplinary consultation (MC) and compares adverse neonatal outcomes (ANOs) before and after medical care at an MC. This study is a retrospective observational study among pregnant women with RD and HT treated at an MC of a university hospital (southern Spain) from 2012 to 2018. Absolute risk reduction (ARR) and number needed to treat (NNT) were calculated. A total of 198 pregnancies were registered in 143 women (112 with RD, 31 with HT), with 191 (96.5%) pregnancies without ANOs and seven (3.5%) pregnancies with some ANOs (five miscarriages and two foetal deaths). Results previous to the MC showed 60.8% of women had more than one miscarriage, with 4.2% experiencing foetal death. MC reduced the ANO rate by AAR = 60.1% (95%CI: 51.6−68.7%). The NNT to avoid one miscarriage was 1.74 (95%CI: 1.5–2.1) and to avoid one foetal death NNT = 35.75 (95CI%: 15.2–90.9). A total of 84.8% of newborns and 93.2% of women did not experience any complication. As a conclusion, the follow-up of RD or HT pregnant women in the MC drastically reduced the risk of ANOs in this population with a previous high risk.

Organization of primary medical care for patients with osteoporosis

2021 ◽  
Vol 25 (2) ◽  
pp. 7-17
Author(s):  
Elena N. Gladkova
Keyword(s):  
High Risk ◽  
Medical Care ◽  
Hip Fractures ◽  
Osteoporotic Fractures ◽  
Population Based ◽  
Subsequent Treatment ◽  
Primary Medical Care ◽  
Screening Programs ◽  
Active Identification ◽  
The World

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

Medical Child Abuse and Homicide

Poisons ◽  
2017 ◽  
pp. 291-296
Author(s):  
David J. George
Keyword(s):  
Child Abuse ◽  
Medical Child Abuse

Pseudobattering in Vietnamese Children

PEDIATRICS ◽  
1976 ◽  
Vol 58 (4) ◽  
pp. 616-618
Author(s):  
Gentry W. Yeatman ◽  
Constance Shaw ◽  
Matthew J. Barlow ◽  
Glenn Bartlett
Keyword(s):  
Child Abuse ◽  
Medical Care

Until recently the presence of linear bruising on children in America was synonymous with child abuse.1 With the large influx of Vietnamese children, physicians should be aware of the practice of coin-rubbing.2 While providing medical care for Vietnamese children at Fort Indiantown Gap, Pennsylvania, we commonly saw petechiae and frank purpura of the chest and back. These lesions were often linear and resembled trauma. Indeed, we received one report of alleged trauma from an outside physician who was not familiar with the condition. The lay practice of Cäo Gió is quite commonly used among the Vietnamese for several symptoms including fever, chills, and headaches.

Medical Child Abuse

2008 ◽  
Author(s):  
Thomas A. Roesler ◽  
Carole Jenny
Keyword(s):  
Child Abuse ◽  
Children And Families ◽  
Comprehensive Description ◽  
University Of Toronto ◽  
Medical Environment ◽  
Bioethics Education ◽  
Medical Child Abuse ◽  
The University ◽  
Important Form ◽  
Sydney Australia

Powerful new detailed and comprehensive resource for diagnosing and treating medical child abuse. Thomas A. Roesler, MD and Carole Jenny, MD, MBA, FAAP make the case that the term Munchausen syndrome by proxy should be retired permanently and replaced with a commonsense appreciation that children can be abused by their parents in the medical environment. Physicians who find themselves providing unnecessary and harmful medical care can see the abuse for what it is, another way parents can harm children. The book offers the first detailed and comprehensive description of treatment for this form of child maltreatment. “At last. A clear, logical, and immensely practical book, showing that this is not a syndrome at all, but rather another important form of child abuse…and one which is completely preventable.” Kim Oates, Emeritus Professor of Pediatrics, The University of Sydney, Australia. “A fantastic book that will revolutionize, in a much needed way, the way we think about this disorder.” Alex V. Levin, MD, MHSc, FAAP, FAAO, FRCSC, Professor, Department of Paediatrics, Genetics, and Ophthalmology and Vision Sciences Director, Postgraduate Bioethics Education University of Toronto. “Drs. Roesler and Jenny have finally mapped the terrain of child abuse showing where medical child abuse stands in the overall landscape.” Thomas L. Dwyer, Director of Foster Care, Department of Children and Families, State of Connecticut.

Abstract TP168: Efficacy of a Pictogram to Promote Stroke Knowledge Among Illiterate Korean Elderly

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cha-Nam Shin ◽  
Jeongha Sim ◽  
Dongchoon Ahn
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Longitudinal Research ◽  
Controlled Trial ◽  
Intervention Group ◽  
Warning Signs ◽  
Repeated Measure ◽  
Control Group ◽  
Control Group Design ◽  
Stroke Knowledge

Background and Purpose: Extensive research supports the importance of knowledge in stroke prevention and reducing prehospital delay time. However, the level of stroke knowledge among Korean older adults remains low. In particular, older adults who are illiterate lack of stroke information despite being at high risk. The purpose of this study was to develop and examine the efficacy of a pictogram to enhance stroke knowledge in the high-risk and illiterate older adults. Methods: We conducted a pretest-posttest nonequivalent control group design study and compared differences in stroke knowledge before and after the intervention. A total of 117 older adults (82 in the intervention group and 35 in the control group) who were 60 years and older residing in community participated in the study. Participants in the intervention group received a pictogram-based education, while participants in the control group received a powerpoint-based education. Stroke knowledge was measured by structured survey questionnaires. Descriptive statistics for sample characteristics, repeated measure ANOVA for the efficacy, and independent t-test for satisfaction comparison between groups were used. Results: The intervention group showed a higher increase in stroke knowledge (F=16.45), awareness of risk factors (F=15.71), stroke warning signs and symptoms (F=17.29), and action at stroke (F=19.36) compared to the control group at p <.001. Also, the intervention group reported that they would recommend the education program to others (t=2.64, p<.05) and the program was applicable to real situation (t=4.47, p <.001), which were scored higher than the control group. Conclusions: The data revealed that a pictogram-based education is more effective than a powerpoint-based education among illiterate older adults. Replicated studies with this pictogram in a larger randomized controlled trial is warranted, which may give greater validity to our findings. Future longitudinal research is recommended to examine retention of stroke knowledge over the long term.

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