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Biomedical subjects

P E Dans

Publications and source records attributed to P E Dans.

At least 19 recordsLinked to original sources
PubMed1992

Medical students and abortion: reconciling personal beliefs and professional roles at one medical school.

A survey was used from 1983 through 1990 in a required first-year course, Ethics and Medical Care, at The Johns Hopkins University School of Medicine, to explore where students drew the line about moral issues. Starting in 1988, a similar questionnaire was administered to each class of fourth-year medical students. This report summarizes the students' attitudes--reported anonymously in both surveys--regarding circumstances under which they would perform or refer for an abortion. Attitudes towards abortion changed little in four years. Comfort levels with patient referral were greatest when the life of the mother was threatened and in the case of rape. Students' attitudes correlated most strongly with personal beliefs about when a fetus was considered a human life and less so with students' genders. The first-year survey results were shared with the students in the course's annual sessions on abortion in order to aid them in understanding the assumptions underlying ethical dilemmas surrounding abortion and to make visible the class's moral pluralism on the subject. The survey also helped them determine their tolerance, if any, for patients' views or actions that conflicted with their personal moral stances.

Abortion, Legal↗
PubMed1992

Reproductive technology: drawing the line.

An anonymous survey was administered to clinical clerks rotating through obstetrics and gynecology during weekly ethics rounds. Students were asked to judge the moral acceptability as participants and as referring physicians of 11 reproductive technology scenarios ranging from artificial insemination using a husband's sperm in a conjugal relationship to instances involving in vitro fertilization, uterine donation, surrogacy contracts, self-insemination, and single or lesbian parenthood. Positive judgments regarding personal moral acceptability ranged from 30-100% and as a referring physician from 36-99%. Though most students were consistent in their judgments about personal and professional moral acceptability, some (1-15%) could see themselves acting as referring physicians for something they personally found morally unacceptable. Those students who were opposed to contracting for children (more women than men) were more likely to find the reproductive scenarios morally unacceptable. This survey seemed to be a useful tool for discussing where students draw the line morally and why, and whether they would distance themselves from actions they found morally unacceptable. This technique for teaching applied analytic ethics is especially applicable to obstetrics and gynecology because it addresses fundamental questions involving day-to-day practice in the specialty.

Attitude↗
PubMed1990

Intravenous drug abuse and one academic health center.

Increasing reports of management problems involving intravenous drug abuse patients prompted our study. From 1983 to 1988, the recorded inpatient prevalence of diagnoses consistent with drug abuse/dependence, other than alcohol or nicotine, rose hospitalwide from 0.6% to 3.5%. Disruptive behavior was documented in the records of 38 of 71 active cocaine or heroin users admitted during 1988 vs 12 of 64 matched control subjects. Care and teaching focused principally on secondary complications of intravenous drug use. Study recommendations included (1) establishment of a comprehensive substance abuse treatment education, and research program with a dedicated inpatient unit; (2) use of an explicit social contract between patients and care givers; and (3) staff education about legal limits in managing disruptive patients and searching for illegal substances. Primary and secondary prevention, including combating societal enabling of substance abuse, should be the institution's long-term goals.

Baltimore↗
PubMed1979

Gerontology and geriatrics in medical education.

The elderly are receiving more attention because of their increasing numbers and because of the substantial public funding for their health and welfare. This article summarizes the findings of an Institute of Medicine committee, whose recently completed report concludes that gerontology (study of aging) and geriatrics (care of the aged) are not covered adequately in medical education. Suggested remedies include increased attention to these subjects in existing medical-school courses, establishment of a complementary required course integrating information from diverse disciplines and emphasis in house-staff training programs on continuous care of the aged in settings other than acute-care facilities. Although an academic discipline of geriatrics is necessary to enhance teaching, research, and specialized patient care, development of a practice specialty would be unwise. More funds for training and research in gerontology and geriatrics are essential to increase the science base and to encourage the development of knowledgeable faculty.

Aged↗
PubMed1978

Gonorrhea detection in posthysterectomy patients.

A retrospective study of women examined at the Venereal Disease Clinic after hysterectomy was made to determine which culture site was most likely to show anogenital Neisseria gonorrhoeae infection when the cervix was absent. Seventeen of 104 such patients were culture positive for N gonorrhoeae. Rates of positivity for our culture sites were as follows: urethral, 17/17 (100%); vaginal, 7/17 (41%); and rectal, 2/17 (12%).

Adolescent↗
PubMed1978

Reversible sudden deafness in early acquired syphilis.

Although congenital syphilis is a well established cause of hearing loss, early acquired syphilis is frequently overlooked in the differential diagnosis of sensorineural deafness. This is due, in part, to a decrease in the incidence of syphilis and to the advent of penicillin in previous years which reduced this complication to a clinical rarity. However, with the increase in new cases of syphilis in the past decade, early acquired syphilitic deafness is being seen with increasing frequency. Along with it is the syndrome of early syphilitic meningitis with sudden sensorineural deafness. This potentially reversible condition should be considered in sexually active patients in whom sudden deafness develops. Early diagnosis and treatment are essential for maximum recovery of hearing.

Adult↗
PubMed1978

Hemagglutination tests for syphilis antibody.

In a study of serodiagnosis of syphilis, the authors compared the specificities and sensitivities of two hemagglutination tests, a sheep-erythrocyte test (MHA-TP) and a trukey-erythrocyte test (TPHA), with those of the Fluorescent Treponemal Antibody-Absorption (FTA-ABS) test. In tests of sera from 935 patients without syphilis, the MHA-TP, TPHA, and FTA-ABS tests were reactive for 0.96, 0, and 1.3% respectively. The false-positive results were usually transient and not associated with underlying illness. For the 68 patients with syphilis, the MHA-TP test was as sensitive as the FTA-ABS test in all stages except untreated primary disease. The TPHA test appeared to be undersensitive, and testing of follow-up sera from persons with latent syphilis showed unexplained conversion of false-negative TPHA results to reactive results. Reproducibilities of the two hemagglutination tests were comparable. The MHA-TP test is a valuable confirmatory test for syphilis. Further study is needed before the use of the TPHA test can be recommended.

Animals↗
PubMed1977

The FTA-ABS test: a diagnostic help or hindrance?

The fluorescent treponemal antibody absorption (FTA-ABS) test, an excellent confirmatory treponemal test, has been used increasingly for syphilis screening and case detection. To evaluate its performance as an initial test, we did Venereal Disease Research Laboratory (VDRL) slide and FTA-ABS tests on 1,043 patients suspected of having syphilis. When retested in both a local and a reference laboratory, sera from 226 patients with borderline or reactive results demonstrated interlaboratory consistency for the VDRL but not the FTA-ABS. Borderline FTA-ABS results correlated poorly with the diagnosis of syphilis in both laboratories; a reactive FTA-ABS test correlated well only in the reference laboratory. Performance of the test appeared to be diminished by its use in a low-prevalence population and by seemingly minor alterations in the test procedure at the local laboratory.

Absorption↗
PubMed1977

Issues along the Potomac: "efficacy" and "technology transfer".

"Efficacy" and "technology transfer" are currently subjects of intense interest to health-related agencies in Washington. These jargon terms refer to assuring that useful knowledge is applied to all who need it and that the application of ineffective technology is discouraged. There is no public or private institution responsible for either assembling data on efficacy or for quaranteeing that necessary studies are undertaken. The determination of efficacy is important for cost control, quality assurance, planning, and any national health insurance plan. Whether engaged principally in practice, teaching, or research, it is important for physicians not only to be conversant with these issues but to participate in the resolution of the questions involved.

Cost-Benefit Analysis↗
PubMed1976

Dysuria in women.

Only 46% of 84 women with dysuria were found to have significant bacteriuria while 8% had gonorrhea, 1% had herpes progenitalis and 17% had monilia and Trichomonas vaginitis. The remainder were considered to have the urethral syndrome. Neither pyuria, microscopic bacteriuria, nor any single subjective or objective datum definitively predicted cystitis at the initial visit. Therefore, we advise formulating the problem as "dysuria" at the initial evaluation even though one treats with an antimicrobial. The initial workup should include a routine urinalysis, gram stain of the urinary sediment, urine culture, an examination of the urethra and labia as well as a urethral culture. Complete pelvic examination is useful in documenting gonorrhea, herpes progenitalis or vaginitis. If the pelvic examination is deferred and the initial urine culture is negative, reevaluation of the dysuria should include a pelvic examination.

Bacteriuria↗
PubMed1975

Politics in the development of a migrant health center. A pilgrim's progress from idealism to pragmatism.

New methods of health-care delivery have been recommended to correct the inequities in the distribution of health services to rural and urban poor. A migrant health center developed in 1970 to accomplish this aim illustrated the many attendant problems. The award of the grant to an outside consumer group rather than to the country health department resulted in political pressures during the center's development. Other factors isolated the center. These included categorical funding specifically directed to a community's ethnic minority and the lack of a regional network of health care. Confusion was created when legitimate spokesmen of the target group, other segments of the local community or interested private and governmental agencies were not defined. Although a program for curative and preventive medicine was established for a minority, the center was less successful in becoming self-supporting and in affecting the social and economic determinants of health.

Agriculture↗