484 Evaluation of a Regional Perinatal Education Program for Health Professionals

Abstract

Wisconsin School o f M e d i c i n e , Department o f P e d i a t r i c s , Madison G a s t r o e n t e r i t i s i s r e c o y n i s e d as a p r e c u r s o r o f t h e HUS b u t i t s r o l e as m a j o r f e a t u r e o f t h i s syndrome i s l e s s w e l l e s t a bl i s h e d . The r e c o r d s o f 12 p a t i e n t s , aged 1 t o 40 y e a r s , i n w h i c a secure d i a g n o s i s o f t h e HUS c o u l d be made on t h e b a s i s o f a c ' r taxotemic r e n a l f a i l u r e w i t h h e m o l y t i c anemia and thrombocytopen i a were reviewed w i t h r e s p e c t t o G I desease. GI c o m p l a i n t s i n it i a t e d the disease i n a l l p a t i e n t s ; 12 had b l o o d y d i a r r h e a , 8 vomited and 7 had cramping abdominal p a i n . These symptoms p e r s i t e d 2 days t o 6 weeks b e f o r e t h e d i a g n o s i s o f t h e HUS was made. Prominent abdominal tenderness was e l i c i t e d i n 8 s u b j e c t s , 2 ha c l a s s i c a l f i n d i n g s o f p e r i t o n i t i s and 5 had hepatomegaiy. P r o c t scopy, performed i n 4 p a t i e n t s , r e v e a l e d f r i a b l e mucosa, 4, l a x anal s p h i n c t e r tone, 2 , a r e c t a l u l c e r a t i o n , and a d i r t y g r a y pseudomembrane. Transaminases were e l e v a t e d i n a l l p a t i e n t s s t u i e d ; SGOT and SGPT ranged from 58 t o 468 and 89 t o 149 IU/L r es p e c t i v e l y . P l a i n abdominal x -r a y demonstrated a s c i t e s , 3, mass i v e c o l o n i c d i l i t a t i o n , I , and thumb p r i n t i n g o f t h e sigmoid c o l o n , I , w h i l e b a r i u m enema, performed i n 2 p a t i e n t s , showed e idence o f d i f f u s e c o l i t i s , 2 , and a 2x2 cm. f i l l i n g d e f e c t i n t i cecum. The i l l~i e s s was m i s t a k e n l y diagnosed as a p p e n d i c i t i s , u l c e r a t i v e c o l i t i s , c e c a l p o l y p , pseudomembranous c o l i t i s o r i n t e s u c c e p t i o n . An appendectomy and a colotomy were n e e d l e s s l y p e rformed. A l l p a t i e n t s recovered normal G I f u n c t i o n w i t h s u p p o r t f o r r e n a l f a i l u r e . We c o n s i d e r G I -l i v e r d i s e a s e t o be a r e g u l a r f e a t u r e o f t h e HUS.A modular, s e l f -p a c e d i n s t r u c t i o n a l orogram i n n e o n a t a l r e s~i r a t o r y d i s t r e s s was p r o v i d e d t o a l l l e v e l s o f h e a l t h p r o f e ss i o n a l s and e v a l u a t e d f o r i t s a b i l i t y t o cause c o g n i t i v e change The program c o n s i s t e d o f 30 media packages ( v i d e o -t a p e and s l i d e t a p e ) and a s t u d y guide. L o c a l h o s p i t a l personnel i n 3 comnunit i e s were r e s p o n s i b l e f o r d i s s e m i n a t i o n o f t h e program t o 187 p o t e n t i a l p a r t i c i p a n t s . 63% o f t h e MO's, 73% o f t h e RN's and 644 o f t h e LPN's completed e i g h t o r more o f t h e packages. C o g n i t i v e change was assessed by w r i t t e n t e s t s a d m i n i s t e r e d b e f o r e and f o l l o w i n g p r e s...