The Mount Sinai journal of medicine, New York
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The increasing use of organophosphorus insecticides in agriculture and inside homes and schools, as well as its widespread existence in the environment, poses a potential health hazard. As the use of these agents increases, acute and chronic exposure has become more common. ⋯ There are few reports about fetal toxicity of organophosphates in the literature because of the relatively few cases reported. In this paper we report a case of intoxication from chlorpyrifos, an organophosphorus compound, during pregnancy, causing fetal death.
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Residents play a pivotal role in the education of medical students and junior house staff but are rarely provided with the tools to help them teach effectively. Residents value their roles as teachers and desire training programs in teaching skills. Teaching skills courses for residents have been shown to improve residents' self-confidence and self-assessed use of effective teaching behaviors. ⋯ This adaptable, seven-hour curriculum has been well received by residents and faculty. We are currently evaluating the effects of the program on residents' confidence and use of learned skills. And we are working to expand this program to every department and to create innovative means of measuring resident competency in teaching and its ultimate effect on student learning.
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Recurrences of inguinal hernias are a not infrequent problem seen by the surgeon. Usually, repair of these hernias is technically more demanding than the original repairs, with potential for a new recurrence, and a higher risk of complications. Open preperitoneal placement of prosthetic mesh is an effective method of repair for such recurrences. ⋯ We present our experience with this technique in 27 patients during a 7-year period. Mean follow-up was 45 months. The procedure was safe (no significant early and late morbidity) and achieved a safe repair (no recurrence during the follow-up period).
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Should physicians be mandated to report domestic violence involving a competent adult patient regardless of whether or not he or she consents to the report? This is a complex ethical and moral issue; in some states such as California, Colorado, Kentucky, New Hampshire, Rhode Island and New Mexico it has become a legal one as well. The Federal health privacy regulation instituted in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) addresses issues of privacy protection for survivors of domestic violence, but it does not preempt those state laws that are less (or more) protective of patient privacy. In the above states, physicians and/or health care providers are mandated to report acts of domestic violence to an agency, under their own circumstances, regardless of whether the physician or health care worker believes that reporting the violence is in the patient's best interest or not. But is mandatory reporting truly "good" or "bad" for the patient, the physician or society as a whole? This article explores the laws and the evidence (including evidence-based research) surrounding the issue of mandatory reporting of domestic violence when it pertains to a competent adult.
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Issues related to informed consent and confidentiality often arise in the emergency care setting. When the patient is an adolescent further complexities are introduced, especially when the desires of the adolescent are different from those of the parent. Understanding when an adolescent can give informed consent and what the limits of confidentiality are will assist medical personnel in providing the most appropriate care. These concepts are elucidated with a specific case.