PubMed Health⌕ Search

Biomedical subjects

P G Krener

Publications and source records attributed to P G Krener.

7 recordsLinked to original sources
PubMed1992

Perinatal toxicology screening.

Accurate identification of substance abusing mothers and their infants is critical for appropriate medical management as well as the collection of accurate information on the effects of illicit drug use on perinatal morbidity, mortality, and long-term neurobehavioral outcome in the infants. This study examines the differences found using two methods for urine toxicology screening at the time of obstetrical admission to the hospital. The institution of universal screening identified significantly more women than were previously identified through the use of a risk-directed protocol (P less than .0001). Women identified using either protocol were significantly more likely than toxicology-negative women to have had poor prenatal care and to have smoked and used alcohol during pregnancy (P less than .001). In the population studied, the multiple criteria needed to accurately identify mothers with positive-toxicology screens would also include screening over one half of the toxicology-negative mothers.

Female↗
PubMed1987

Impact of the diagnosis of AIDS on hospital care of an infant.

Detailed analysis of caretaker response to the first infant newly diagnosed with AIDS at a university hospital was done by review of nursing notes for three periods: before diagnosis of AIDS, after diagnosis, and after psychiatric consultation. Five consultation questions were posed, and the findings on investigation of these questions are discussed. It was found that the percentage of time that PRN medication was given dropped after diagnosis of AIDS but rose above the initial level after the consultation. The number of times per shift the nurse touched the baby (TLCs) was not found to be associated with use of PRN medication; rather it was explained by which nurse was caring for the child. This study focuses on variations in nursing care of one infant to illustrate how variation in caretaker response can amplify the range of perturbations of the infant's behavioral response. It is speculated that caretakers of patients with AIDS may normally have feelings considered unacceptable in medical settings, including fear, blaming the patient, or a wish to avoid the patient. Such feelings are more difficult to tolerate in the care of children or infants and are superimposed upon the familiar stains associated with the care of chronically ill or dying pediatric patients.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Psychiatric liaison to liver transplant recipients.

Child psychiatric consultants perform psychiatric assessment and liaison among various clinical services. Execution of these familiar roles for pediatric liver transplantation recipients exposes unfamiliar and difficult bioethical problems. Administrative problems arise if the recipient's suitability is too narrowly evaluated. Assessment may be time-limited. The intensive care unit environment and the VIP characteristics of child transplantation patients may distort observations and constrain opportunities for preventive preoperative psychologic management. Unnecessary psychiatric complications may ensue, which imperil the transplantation surgery. The primary caretakers may have an extraordinary emotional investment, so liaison is pressured. Three cases are presented to illustrate these points. Medical ethical perspectives and the limitations of medical training to prepare physicians to perceive them are indicated. That these limitations also affect the psychiatrist is acknowledged, and a clinical research approach is suggested.

Adolescent↗
PubMed1986

Relation of family factor to treatment outcome for bulimic patients.

The psychotherapy of 25 normal weight bulimic adolescent and late adolescent women (age 15-32 years, mean = 21 years), was reviewed to evaluate developmental and diagnostic precursors and the outcome of psychoanalytically oriented long-term therapy (mean = 33 sessions). Psychotherapy outcome was scored in these categories: bingeing and purging; food obsession; school/work satisfaction; equilibration with family of origin, and achievement of heterosexual closeness. On factor analysis, all factors loaded highly and a global outcome score was derived which was used as the dependent variable in a step-wise regression analysis with 18 family factors as independent variables. To identify family patterns that predicted degree of improvement, a multiple regression analysis was performed. Results indicated that family variables associated with maternal warmth explained an appreciable proportion of the variance in outcome. Such a finding is consistent with the formulation that patients with benign archaic maternal representations were better able than their counterparts with less benign maternal images to form a positive transference and better working alliance with the (female) therapist.

Adolescent↗
PubMed1984

Death and the pediatric house officer revisited.

Thirty-six third-year pediatric residents at four Western university training programs were interviewed individually and retrospectively about the magnitude of their clinical experience in managing the treatment of chronically ill and dying children, as well as the psychosocial educational curriculum of their training program as it pertained to these experiences. The residents managed an average of 35 dying children during their first 2 1/2 years of pediatric residency. They imparted the news of a potentially fatal disease to an average of 33 families during this same time span. There was a disparity between the magnitude of the clinical experience and the time and emphasis on these issues in the residency curriculum. The implications of these findings for an improved educational curriculum in the psychosocial care of dying children are discussed.

Adult↗