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Biomedical subjects

T J Silber

Publications and source records attributed to T J Silber.

At least 37 records · Page 2Linked to original sources
PubMed1989

Anorexia nervosa. Hospitalization on adolescent medicine units and third-party payments.

To determine the appropriateness of hospitalization for patients with anorexia nervosa on an adolescent medicine unit, major and minor criteria justifying admission were developed. Hospitalization was considered necessary when one major and three minor, or six minor, criteria were met. A retrospective review of 20 patient records was conducted and all met the criteria. Eighteen patients were discharged with objective findings of improvement. Two were transferred to a psychiatric unit for prolonged care. A review of the financial records disclosed that four hospitalizations had been contested (partially or in total) by the patients' insurance company. Thus, in 20% of the records meeting the criteria for admission third parties refused to pay. Because insurance company denial may seriously undermine therapy and adversely influence outcome, it is proposed that a category of "Malnutrition Secondary to Anorexia Nervosa" be accepted as reimbursable under medical coverage for acute care treatment in qualified adolescent medicine units.

Adolescent↗
PubMed1989

Career satisfaction in adolescent medicine. A survey of physicians trained over a 20-year period.

National data are available on the career undertakings of those trained in adolescent medicine, but longitudinal data on actual career and job satisfaction is lacking. Forty-five physicians trained in adolescent medicine from 1965 to 1985 at a large urban teaching hospital were surveyed using the Jewitt/Greenberg Career Satisfaction Questionnaire. Thirty two (71%) responded. Twenty-one (66%) were primarily in practice, eight (25%) were in academic medicine, and three (9%) were involved in administration. Five (16%) had careers in adolescent and/or young adult health care. Thirty-one (97%) claimed to at least "like" their career, and 29 (91%) felt "satisfied." Only three (9%) desired to change their career, but 11 others (34%) stated they would if they could have an equal opportunity in a new career. Four individuals (13%) would not have chosen medicine if given another chance, and 12 (30%) would not have chosen pediatrics. Greatest satisfaction was derived from patient care activities (62%), the actual work site and job (50%), and finances (40%). Dissatisfaction resulted from too little money (34%), inadequate time (25%), administrative problems (22%), and patient-related problems (22%). A large majority (72%) desired to be acknowledged as specialists. This review of graduates from a single program provides a unique perspective on the ultimate careers of trainees. A similar review of other programs may help facilitate teaching and correct programatic deficiencies. This review also suggests that careful thought should be given to a way of properly acknowledging, as specialists, those trained in adolescent medicine.

Adolescent Medicine↗
PubMed1989

Anorexia nervosa and schizophrenia in an adolescent female.

A 14-year-old adolescent female with a previously unrecognized psychosis of 2 year's duration developed anorexia nervosa. The correct psychiatric diagnosis was made during a standardized clinical interview. On the NIMH Diagnostic Interview Scale for Children it was possible for the patient to reveal her psychotic symptoms. This case supports the view that anorexia nervosa may exist in a continuum that parallels ego development, ranging from neurotic, to character disorder, to psychotic.

Adolescent↗
PubMed1988

Reflex sympathetic dystrophy syndrome in children and adolescents. Report of 18 cases and review of the literature.

Reflex sympathetic dystrophy syndrome is a well-recognized disorder in adults, but it is rarely diagnosed in the pediatric age group. This report summarizes our experience with this condition from 1975 to 1985. We diagnosed, treated, and followed up this condition in 18 children and adolescents. The condition usually followed trauma. The most prominent feature in all patients was a constant limb pain with episodes of paroxysmal exacerbation. The pain was associated with two or more of the following: edema, hyperhidrosis or anhidrosis, cyanosis or erythema, and, in severe cases, dystrophic skin changes and muscle atrophy. Roentgenograms were normal. Bone scans were helpful to exclude other possible causes of bone and joint pain. Reflex sympathetic dystrophy syndrome in children probably often goes unrecognized, sometimes being confused with psychiatric conditions such as conversion reaction and malingering. Reflex sympathetic dystrophy syndrome should always be considered in the differential diagnosis of unexplained persistent limb pain in children: early recognition and proper management may result in the prevention of potentially crippling sequelae.

Adolescent↗
PubMed1988

Recurrent genital ulcers in an adolescent as a manifestation of Behçet's disease.

An adolescent with a history of recurrent genital ulcers had a negative evaluation for sexually transmitted diseases. A clinical suspicion of Behçet's disease was supported by a biopsy of one lesion. The condition may be more frequent than suspected as the signs (arthritis, mouth ulcers, neurologic abnormalities) may be so mild or separate in time that they could be easily overlooked.

Adolescent↗
PubMed1987

Acquired pseudo eating disorder. An imitation or fabrication of anorexia nervosa.

Acquired pseudo eating disorder is a condition characterized by the development or fabrication of symptoms corresponding to an eating disorder in a patient hospitalized for an unrelated medical illness, who has previously been exposed to a patient(s) with anorexia nervosa. Two adolescent patients developed an eating disorder during medical hospitalization. Both acquired the condition while hospitalized for another reason (myelomeningocele and multiple sclerosis, respectively). The potential psychodynamics suggested the selection of an "eating disorder," amenable to control, over the reality of a threatening illness that was experienced as being out of control. Thus, the new and dramatic symptoms appeared to serve as a defense against a pervasive underlying depression. The patient's loudly proclaimed "eating disorder" seemed to originate from the imitation of anorexia nervosa patients. Recognition of this hospital-acquired pseudo eating disorder and appropriate counseling resulted in rapid resolution of the symptoms. It is possible to identify a pseudo eating disorder developing during a hospitalization and differentiate it from "true" anorexia nervosa.

Adolescent↗
PubMed1987

Ethical and legal issues in adolescent pregnancy.

A review of the health consequences of adolescent pregnancy indicates that pregnancy in adolescents has a higher mortality rate than that of legal abortions. The rights of minors to give consent to medical care is expressed in the mature minor doctrine and has been extended, with some limitations, to the abortion decision. Efforts to persuade adolescent patients that they should involve their parents in their medical care may be very beneficial; however, when this cannot be achieved, the adolescent should receive confidential medical care, with the adult professional assuming a protective role.

Adolescent↗
PubMed1987

Adolescent marijuana use: screening and ethics.

Adolescent marijuana use is an issue of concern to the entire community. The emergence of technology that can identify marijuana use poses questions relating to public health issues such as justification and extension of screening. This article discusses the moral issues relating to surveillance of adolescent marijuana use and postulates a justification for clinical screening.

Adolescent↗
PubMed1987

Adolescent marijuana use: the role of the physician.

Adolescent marijuana use is an issue of concern to the community at large. Physicians now have the technology to identify marijuana use and thus are in a unique position to deal with the issue. This article addresses the moral issues related to screening and surveillance of adolescent marijuana use and postulates the justification for active physician intervention.

Adolescent↗
PubMed1986

Usefulness of a review of systems questionnaire in the assessment of the hospitalized adolescent.

A study was conducted to assess whether a standard questionnaire, the Mile Square Youth Clinic Questionnaire, could enhance communication between patients and physicians, leading to an improvement in the care of the hospitalized adolescent. Each questionnaire was compared with: validated concurrent notations on the medical record, and the history recorded in the patient's outpatient chart. Eighty-two of the 100 patients completing the questionnaire presented new information resulting in a better understanding of the individual patient's needs. The new concerns elicited could be categorized into six groupings: personal/family (19.4%), school/friends (17.8%), body/weight (17.2%), somatic concerns/cancer (26.7%), sexuality/birth control (12.2%) and drinking/drugs (6.7%). Most patients had more than one area of concern. The study supports the usefulness of a review of systems questionnaire as a method of data gathering for the hospitalized adolescent.

Adolescent↗