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Domestic violence is occurring in epidemic proportions in the United States. Recent surveys have shown there is a need for educational programs for health care professionals. This report presents the results of a domestic violence workshop developed to increase knowledge and improve attitudes and skills in working with victims of domestic violence. The results of the workshop, measured by preintervention and postintervention attitude, knowledge, and skills surveys, are promising. There was a significant improvement in knowledge, self-assessed skills, and attitudes after the workshop. Although the full magnitude of the changes was not sustained over time, there was still significant improvement after 6 months in knowledge and attitude. Rates of detection and documentation did not change. Future educational programs will need to address maintaining routine screening for domestic violence in the primary care setting and to highlight more clearly the role of health care professionals in the detection and treatment of domestic violence. A pproximately 4 million women in the United States are battered by their partners each year, resulting in 4,000 deaths. 1 It has been shown repeatedly that approximately one third of women seeking medical care in emergency departments are victims of domestic violence. 2 In primary care settings, 14% to 28% of female patients are domestic violence victims. 3 Recently, domestic violence has been more highly publicized, leading to an increased public awareness of this epidemic. However, most physicians lack the knowledge, skills and attitudes necessary to correctly identify and care for domestic violence victims. 2,4-7 Several medical centers have developed domestic violence training programs for residents and students. 8 However, there have been few, if any, evaluations of the efficacy of domestic violence training on the subsequent behaviors and attitudes of trainees. 9 In this study, we evaluated the impact of a 4-hour domestic violence training workshop on knowledge, behavior, and attitudes of medical residents. We hypothesized that the educational intervention would significantly increase residents' knowledge, skills, and attitudes and increase the number of patients screened, detected, and documented in medical records. METHODSFifty-five residents participated in this study; 34 (62%) were male and 21 (38%) were female. All were residents in the 3-year Medical College of Pennsylvania Internal Medicine Residency of the Allegheny University of the Health Sciences. Each resident was required to attend one domestic violence workshop. Five identical workshops were held over a 2-week period, each replacing one continuity clinic session. The InterventionThe 4-hour workshop included the following: Surveys. Participants filled out a Doepel Domestic ViolenceSurvey, 10 before and after the workshop. This survey measured residents' knowledge, attitudes and self-assessed skills. The survey consists of multiple-choice questions, true/false questions, and attitude items that require a response on...

Sirolimus is an immunosuppressive agent approved for prophylaxis of acute rejection in renal transplant patients aged 13 years or older. A retrospective review of pericardial effusion coincident with sirolimus therapy was conducted from key clinical trials and spontaneous reporting sources. A significantly higher rate of pericardial effusion occurred with sirolimus versus azathioprine treatment in a cardiac transplantation trial (28.6% versus 9.3%, respectively). Cases of pericardial effusion were also observed in the sirolimus treatment arms of three de novo renal transplant studies (rates 0.5 to 1.9%). Although most of the pericardial effusions occurred in cardiac transplantation, sirolimus is not approved for this use. As of January 31, 2007, the Wyeth safety database (which includes clinical trial data and spontaneous reports) contained reports of pericardial effusion in 56 sirolimus-treated patients, 31 of whom required pericardial drainage. These data suggest that pericardial effusion should be considered in the differential diagnosis of a clinical deterioration in posttransplant patients treated with sirolimus. The adverse reaction of pericardial effusion has been added to product labeling.

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Preview Drug-induced aseptic meningitis is an unusual adverse reaction associated with a number of medications. In this report, the authors present a case related to use of trimethoprim- sulfamethoxazole and summarize the available data regarding various proposed mechanisms of drug-induced meningitis. The usual clinical presentation and course of the disorder are discussed.