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Biomedical subjects

S Menahem

Publications and source records attributed to S Menahem.

At least 91 records · Page 5Linked to original sources
PubMed1987

Interviewing and examination skills in paediatric medicine: videotape analysis of student and consultant performance.

Taking an adequate history and competently examining a patient remain essential prerequisites for making a diagnosis. Four 5th year medical students who had completed 18 months of clinical teaching were assessed at the start and end of their ten-week paediatric term and compared with 4 experienced consultants. A videorecording was made of each patient encounter. The students' history was often incomplete, at times inaccurate and imprecise, despite earlier provision of a framework to obtain the necessary information. The students spent a great proportion of their time examining the child, yet their findings were questionable particularly if the child was uncooperative. The second recording made at the end of the student's paediatric term revealed a general improvement in their confidence and knowledge, though similar deficiencies were observed. The consultants, as expected, did better. They also showed a greater awareness of understanding the child within the context of his family. They spent more time interviewing the parent and child, offered a fuller explanation of the diagnosis and carefully reviewed the management. These findings further emphasize the need to improve and assess the clinical performance of students.

Clinical Competence↗
PubMed1987

Teaching students of medicine to listen: the missed diagnosis from a hidden agenda.

This paper describes the ability of 4 senior students to recognize and deal therapeutically with the hidden agenda of patients--the covert concerns or second diagnosis other than the presenting problem. This naturalistic study was hospital-based and used ambulatory patients with common paediatric problems. The patient encounter was videotaped and subsequently analysed to determine the patient's hidden agenda. The findings indicated that the students had some difficulty in correctly diagnosing the patient's presenting problem or primary diagnosis. They also failed to recognize and deal with their patients'/parents' hidden agendas. The relevance of these findings to patients care is discussed.

Child↗
PubMed1986

Evaluation of aortic valve prolapse in ventricular septal defect.

Angiographic criteria for the recognition of aortic valve prolapse in isolated ventricular septal defect were based on the degree of aortic cusp deformity and the presence or absence of aortic regurgitation. Ninety eight consecutive patients with isolated perimembranous or infundibular ventricular septal defects who were catheterised and had aortography performed were reviewed. They included five with postoperative ventricular septal defects and three with additional mild right ventricular outflow tract obstruction. Eighteen were found to have aortic valve prolapse. Although eight of the 18 were noted to have aortic regurgitation angiographically, only three had an early diastolic murmur. Only eight of the 18 patients had cross sectional echocardiographic findings suggestive of prolapse. All of these had at least moderate prolapse angiographically. Cross sectional echocardiography was found to be insensitive in diagnosing mild degrees of aortic valve prolapse. A trend towards a decreasing left to right shunt was noted as the degree of aortic valve prolapse increased. Spontaneous decrease in the size of a ventricular septal defect may be due to unrecognised aortic valve prolapse without clinical evidence of aortic regurgitation.

Adolescent↗
PubMed1985

A multidisciplinary approach to the management of psychosocial admissions to a general paediatric ward.

This study investigated the characteristics of all new in-patients with major psychological and/or social problems admitted to a medical ward over a 4-week period. Fifteen successive patients were studied prospectively. The professional time spent by the medical and paramedical personnel involved in the initial assessment and management was reviewed, and the children followed-up 6 months later. The study found that the patients readily fell into two major groups. Group I were infants and children who had been maltreated or were at risk for child abuse. Group II were older children who presented with psychosomatic symptoms arising from disturbed family or environmental backgrounds. The medical, psychiatric and social work input was considerable for both groups (19 vs 27 h per patient respectively). Their hospital stay was prolonged (15 vs 21 days respectively; the hospital average was 4.4 days). The outcome differed in the two groups. Patients in Group I failed to attend follow-up appointments in most cases unless such attendance was legally mandatory. In contrast, Group II patients usually kept their follow-up appointments, the intervention generally being successful.

Adolescent↗
PubMed1985

Respiratory syncytial virus and heart block--cause and effect?

A child aged 3 years who developed a respiratory syncytial virus infection is described. His admission was complicated by the development of an irregular pulse. He initially had a variable first or second degree heart block with transient electrocardiographic evidence suggestive of pericarditis and/or myocarditis and later developed complete heart block. He has remained asymptomatic for the past four years. A search for other causes of the heart block proved negative. It is tempting to suggest an association between the acute RSV infection and the development of the heart block but such an association at this stage remains speculative.

Acute Disease↗
PubMed1984

Possible conservation-withdrawal reaction in two infants.

Two breast-fed infants with weight loss are described. Despite their mothers' assertions that their breast-feeding was adequate, the infants gained weight rapidly on complementary feeding and became more responsive. Previously they had rather passively accepted suboptimal intakes, crying little and sleeping excessively. Discussion centers on whether these infants illustrated the conservation-withdrawal state, since apart from their poor weight gains, they were otherwise well.

Adjustment Disorders↗
PubMed1984

The role of the consultant pediatrician in community pediatrics--an Australian perspective.

The consultant pediatrician plays an important role within the community. The task includes assessing the child in all parameters, appropriately treating organic disease, and making efforts to understand and manage the emotional difficulties that may be present. This paper reviews the work of a consultant pediatrician within the community, emphasizing the importance of preventing disease and emotional ill-health in the child and family.

Australia↗
PubMed1983

Possible "outbreak" of Kawasaki disease in Victoria.

Kawasaki disease, a multisystem disorder of unknown cause, which primarily affects young children, has been recognized in many countries and previously reported in Melbourne. The condition is usually endemic, but has occasionally been reported in clusters or epidemics. Such an apparent "epidemic" occurred in the winter of 1981. This paper highlights the clinical features, the results of investigations and sequelae of this disorder in the seven children admitted to the Royal Children's Hospital, Melbourne, during that period. Possible aetiological factors were sought, but none was found.

Australia↗
PubMed1983

Understanding the management of the child with pain.

Pain experienced by the child or perceived by the child's parents generally results in the child being taken forthwith to the doctor. Often the cause of the pain is obvious, such as an injury or an "acute" abdomen, and resolution may be readily achieved with the aid of medical science, the concern of the doctor, and the dedication of the parents. However, there are situations in which, despite the full resources of the physician and other helping professionals, resolution of the child's pain may not be forthcoming. This can particularly be observed in infants and children who are at risk and may have injuries inflicted by the persons looking after them. Infants and children may experience, or are thought to experience, pain in a recurrent and often troublesome way. Yet physical examination often reveals no abnormalities and further investigation is unhelpful. Resolution of the pain requires an understanding of the meaning of the pain to the child and its significance within the family. The clinical features of this kind of pain are described to highlight those aspects which may be helpful in its resolution.

Abdomen↗
PubMed1983

Cardiovascular manifestations of Kawasaki disease Royal Children's Hospital, Melbourne, experience 1974-1981.

A review was undertaken of all patients with Kawasaki disease admitted to the Royal Children's Hospital. Their cardiovascular manifestations were reviewed and found to be similar to those reported overseas. The series totalled 21 patients, including five who developed cardiac failure. There were three deaths. Treatment varied but was mainly supportive though low dose aspirin has increasingly been used.

Aneurysm↗