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D Hardoff

Publications and source records attributed to D Hardoff.

At least 19 recordsLinked to original sources

Training physicians in communication skills with adolescents using teenage actors as simulated patients.

Role-play exercises with simulated patients may serve the purpose of training professionals to develop appropriate communication skills with adolescents. Authentic adolescent responses toward the physicians may be achieved by actors who themselves are in their teenage years. We describe our experience in continuing medical education programmes for primary care physicians aimed at improving their skills in communicating with adolescents, using simulation methodology with teenage actors. Eight 16-17-year-old actors from the drama department of a high school for the arts were trained to simulate 20 cases with characteristic adolescent medical problems, as well as confidentiality issues and home and school problems. The actors performed in front of large groups of 20-30 paediatricians, family practitioners, or gynaecologists in continuing medical education. Diagnostic issues as well as therapeutic and management approaches were discussed, while the actors provided feedback to the trainees about their understanding and their feeling regarding the issues raised during the exercises. Normally, smaller learning groups are more suitable for such training purposes; nevertheless the participants could appreciate learning the principles of careful listening, a non-judgmental approach and assuring confidentiality. A collaboration of medical schools and postgraduate programmes with high schools which have drama departments may be fruitful in the teaching of adolescent medicine with special emphasis on communication skills with teenagers.

Adolescent↗

Attitudes and practices of Israeli physicians toward adolescent health care: a national survey.

PURPOSE: To assess practices and attitudes of Israeli physicians with regard to adolescent health. METHODS: Questionnaires were sent to a sample of 1050 Israeli physicians specializing in pediatrics (P) family practice (FP), and internal medicine (IM). They were requested to report their experience, perceived skills, and desire for further training regarding 16 adolescent health items grouped under four topics: medical, sexuality, risk behavior, and psychosocial problems. A scoring system was applied to assess their report. Attitudes toward confidentiality in the same topics were also surveyed. RESULTS: Questionnaires were received from 306 (29%) physicians, of whom 42% were P, 35% were FP, and 29% were IM. The majority (96%) of respondents included adolescents in their practice, and adolescents comprised 33%, 17%, and 11% of the registered patient population of the P, FP, and IM, respectively. The mean scores for practice, perceived skills, and desire for further training were generally low. Analysis of variance revealed significant differences among the three physicians groups in all surveyed topics, resulting from the low scores of the IM group. A diversity regarding confidentiality was noted, in that younger FP were most willing to keep health issues confidential. CONCLUSIONS: Physicians in Israel have limited experience and perceive themselves to be underskilled in dealing with adolescent health issues. Training programs in adolescent health need to be developed to meet the needs of physicians in Israel.

Adolescent↗

The role of the capnography head-up tilt test in the diagnosis of syncope in children and adolescents.

OBJECTIVES: To evaluate the role of the capnography head-up tilt test (CHUTT) in the diagnosis of syncope in pediatric patients. METHODS: The CHUTT is a head-up tilt test with concomitant capnometry. Hyperventilation on CHUTT was diagnosed when the patient's end-tidal carbon dioxide pressure (ETPCO2) was </=25 mm Hg. Hyperventilation syncope was diagnosed when three criteria were met: loss of consciousness, ETPCO2 </=25 mm Hg, and no significant drop in blood pressure. The cohort included 65 consecutive children and adolescents (mean age, 14.2 years) who were assessed for syncope by routine investigations and CHUTT. RESULTS: The cause of the syncope was established in 67% of cases: cardioinhibitory reaction in 17%, vasodepressor in 20%, psychogenic in 22%, and mixed neurally mediated-psychogenic in 8% of the patients. The history indicated a cause of syncope in 40%, the CHUTT in 49%, and a combination of the history and positive CHUTT in 66% of patients. Neither the patients' clinical data nor values of the blood pressure, heart rate, respiratory rate, and ETPCO2 measured during recumbency predicted which patients would manifest hyperventilation or hyperventilation syncope on tilt. CONCLUSIONS: The CHUTT contributes substantially to the diagnosis of syncope in pediatric patients. The CHUTT advances the understanding of the pathophysiological mechanisms of syncope and enables the physician to reassure the patient regarding the essentially benign nature of the condition. Because it is not possible to predict which patients would develop a hyperventilation syncope on the standard tilt test, the modification of this procedure by measuring the ETPCO2 for the assessment of children with syncope should be considered.

Adolescent↗

The clinical significance of rigors in febrile children.

UNLABELLED: The objective of the study was to evaluate the significance of rigor as a predictor of bacterial infection in hospitalized febrile infants and children. One hundred febrile children with rigor were studied and compared to 334 febrile matched controls without rigor. All underwent clinical evaluation and appropriate laboratory investigations. The patients were then divided into "bacterial" and "non bacterial" infection groups, as defined in the text. It was demonstrated that 66% of the patients with rigor belonged to the bacterial infection group versus 50% in the non-rigor group (P < 0.005). There was a significantly greater yield of positive blood cultures in the patients with rigor (P < 0.04), especially those over the age of 1 year (P < 0.015). The only laboratory examination of potential value as a predictor of bacterial infection in children with rigor was the band count. An absolute band count of more than 1500/mm was significantly more frequent in the rigor group (P < 0.003), and the combination of a rigor and band count of more than 1500 increased the relative risk for a bacterial infection by a factor of 1.35. These data demonstrate that rigor in hospitalized febrile infants or children significantly increase the likelihood of bacterial infection. CONCLUSION: Although the absence of rigors in febrile children does not exclude bacterial aetiology, their presence significantly increase the probability of an infection requiring appropriate workup and a reader institution of antibiotic therapy.

Adolescent↗

The capnography-tilt test for the diagnosis of hyperventilation syncope.

We describe the capnography tilt test (CTT) for the diagnosis of hyperventilation syncope. The CTT is a 10-min supine, 30-min head-up tilt test with simultaneous monitoring of end-tidal PCO2 (ETPCO2). Hyperventilation (HV) was defined as ETPCO2 < or = 25 mmHg. Hyperventilation syncope (HV syncope) was defined as loss of consciousness with ETPCO2 < or = 25 mmHg and no significant drop in blood pressure. Four groups of patients had the CTT: group I (n = 14), patients presenting with syncope who during a prior tilt test had lost consciousness without concomitant fall in blood pressure; group II (n = 50), syncope, primary evaluation, no prior tilt test done; group III (n = 20), generalized anxiety disorder, no syncope; group IV (n = 80), arterial hypertension, no syncope. Hyperventilation was found in 11/14 patients in group I, 5/50 in group II, 7/20 in group III, and none in group IV; HV syncope was diagnosed in seven patients, all in group I. None of the parameters measured in the evaluation, including ETPCO2, predicted HV syncope on tilting. The mechanisms of resting HV and HV during tilt are not well understood. We confirm the existence of HV syncope. The tilt test should probably be used to screen patients presenting with syncope, with the CTT reserved for patients who lose consciousness during the tilt test without an associated fall in blood pressure, as HV is not always clinically obvious.

Adolescent↗

The adolescent parturient: a study of an Israeli population.

The aim of this study was to describe the frequency and characteristics of adolescent deliveries and to identify issues that might require intervention, in Haifa District, which is the third largest in Israel. The specific objectives were to assess the prevalence of 15-19-year-old parturients in the district, to characterize the younger (15-17-year) age group for demographics and educational status as well as for pregnancy and delivery progress, to describe the newborn babies of these mothers, and to compare the Jewish and Arabic subpopulations within the younger group for these parameters.

Adolescent↗

Indirect calorimetry in the nutritional management of eating disorders.

The caloric prescription, a key component of the nutritional therapy of anorexia nervosa (AN) and bulimia nervosa (BN), may be empirically prescribed, or based on predicted resting energy expenditure (REE), yet adaptive changes in the metabolic rate may render both methods unreliable. Indirect calorimetry measurement of fasting REE was obtained in 32 patients with AN (n = 21) or BN (n = 11). Predicted REE was calculated according to the Harris-Benedict equation, and empiric caloric prescriptions were made by experienced physicians. In the AN group, mean measured REE was significantly lower than predicted REE (p = .00). The empiric caloric prescription was, as intended, significantly higher than the measured REE, but the two methods correlated significantly (r = .53, p < .05). The predicted REE overestimated caloric needs but was also highly correlated with measured REE (r = .69, p < .001). By regression analysis, measured REE could be calculated from predicted REE as follows: measured REE (Kcal/day) = (1.84 x Harris-Benedict predicted REE) - 1,435. In the BN group, mean measured REE was not significantly different from the empiric caloric prescription (p = .09) but was significantly lower than the Harris-Benedict predicted REE (p = .022). Neither correlated with measured REE in BN. Therefore, in BN indirect calorimetry is the only reliable method for determining caloric needs. In AN indirect calorimetry remains the preferred method, but when not available, we recommend the above equation to determine resting energy requirements.

Adolescent↗

Medical complications in male adolescents with anorexia nervosa.

PURPOSE: Medical information on male anorectics is scant. We present data on 10 males with anorexia nervosa, who were treated at our Eating Disorders Center during a twelve-year period. METHODS: Retrospective chart review. RESULTS: All patients were malnourished weighing 80% or less of their ideal body weight with a mean B.M.I. of 13.5 +/- 2.0. Height below the 50th percentile was evident in 80% of the patients, and was below the 10th percentile in 30% of the patients. Structural brain changes on brain computerized tomography scans were noted in seven out of nine patients and more than 50% had mild anemia relative to the Tanner stage. Other findings included a mean presenting heart rate of 68.3 +/- 17: four out of ten patients had presenting heart rates of 80 or greater and of these, three had serious medical problems and were severely malnourished. Two patients had cardiac complications and one had a life-threatening electrolyte disturbance. CONCLUSION: Despite the small number of patients, the proportion of male adolescent anorectics with medical abnormalities seems high, and may be due to difficulties in establishing the diagnosis and delay in seeking medical attention. Patients who had heart rates of 80 or greater were perhaps sicker and further along in their development of congestive heart failure, thus explaining their initial relative tachycardia. We suggest a higher index of suspicion for congestive heart failure and closer medical monitoring when a malnourished adolescent with anorexia nervosa presents with relatively elevated heart rates.

Adolescent↗

A school-linked health service for adolescents in Jerusalem.

This paper describes the Adolescent Health Service (AHS) and its multidisciplinary, school-linked, community-based adolescent health clinic located in a western neighborhood of Jerusalem. Files of the first 134 adolescents who completed or discontinued treatment in the clinic during the first two years of operation were reviewed for demographic data, referral source, number of visits, health concerns and clinical impressions. The clinic population included Jewish Jerusalem residents, ages 12-18, 75% of whom were female. Most referrals came from schools. The average number of visits per patient was five (range 1-20). The most frequent presenting concerns as well as the most frequent clinical impressions were in the psychosocial and nutritional domains. Concordance between presenting concern and clinical impression was 61% (k = 0.47). Health problems of Israeli high school students attending the clinic mainly were psychosocial and nutritional. The school-linked health service applied a comprehensive approach to the biopsychosocial needs of adolescents, not addressed at other health services.

Adolescent↗

Self-assessment of pubertal maturation in socially disadvantaged learning-disabled adolescents.

Reasonable concordance has been demonstrated between physicians assessment of pubertal maturation and self-assessment by healthy adolescents studying in the mainstream educational system. The purpose of this study was to determine whether pubertal maturation self-assessment may be used as a reliable screening instrument in learning-disabled adolescents. Self-assessment of sexual maturation, was investigated in 80 7th- and 8th-grade Israeli students studying in a residential school for socially disadvantaged learning-disabled adolescents of normal intelligence (LD group), and in 63 Israeli students of the same age group attending a mainstream urban school (C group). All 143 students were examined by one investigator for their annual physicals, and clinical assessment of Tanner stage was then performed. Following the examination students were asked to identify their present pubic hair maturation stage according to Tanner plates. Of the LD group, 58% assessed their pubertal stage in agreement with the investigator's assessment as did 70% of the C group. Underestimation of pubertal stage was more common in students more advanced in their pubertal development, and overestimation was more common among students who were less advanced in their maturation. Within approximation of one Tanner stage difference between the examiner and student assessments, concordance rate reached 95% in both groups. Self-assessment of pubertal development in school settings may be used as a reliable screening instrument in learning-disabled adolescents with normal intelligence, when an approximation of one developmental stage is accepted.

Adolescent↗

Hyperlipidemia.

In the industrialized world coronary artery disease associated with high plasma cholesterol levels accounts for more death and disability than any other disease group. The various disorders that lead to hyperlipidemia often begin in childhood or adolescence. Early attention to these problems can reduce risk for mortality and morbidity in later life.

Journal Article↗

Developing community-based services for youth with disabilities.

Five community-based services in Israel for disabled adolescents are described. Three of them are day centers and two are afternoon clubs. They provide rehabilitation resources for teenagers with various kinds of disabilities including cerebral palsy, mental retardation, blindness, deafness and emotional handicaps. These services are analyzed and discussed with regard to addressing the major needs of adolescents with disabilities, with the aim of achieving an optimal degree of independence and preparation for normalized life. The programs include resources such as vocational rehabilitation, independent living education, recreational activities, social skills training, sexuality education in addition to creating opportunities to mix and socialize with nondisabled youth. The function of pediatric and adolescent medicine physicians in such services is emphasized as imperative in providing a comprehensive rehabilitation program for youth with disabilities.

Adolescent↗