The Mount Sinai journal of medicine, New York
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Case Reports
An exploration of the ethical, legal and developmental issues in the care of an adolescent patient.
Providers of health care to adolescent patients face numerous challenges. In addition to increased risk for many health problems, adolescent patients may bring complex ethical, legal and developmental questions to bear as they seek medical services. This article describes the case of one such adolescent patient and discusses some of the attendant issues faced by her physician. ⋯ Additionally, providers must be aware of financial barriers and they need to acquaint themselves with available services such as New York State's Family Planning Benefit Program. Attention to their patients' stages of cognitive and emotional development should inform providers' advice to adolescents, and an understanding of the importance that supportive adult relationships play during adolescence is essential to fostering healthy development. Open communication between adolescent patients and their parents or guardians should be encouraged, while maintaining the primary obligation of providing confidential care.
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This paper reviews the development of the concept of medical futility, particularly as it applies to pediatrics. It discusses the difference between technical considerations and value considerations in futility determinations, and then breaks down the concept of futility into four components - power, money, trust and hope.
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Parents often make medical decisions for their children. As pediatricians, we must be sure that the decisions are medically informed. At times, we may disagree with the decisions that parents make and must decide if they are acting in the best interest of their child. This article presents a case in which these issues arose regarding a child with trisomy 13.
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Heart failure is a disease that effects affects approximately 5 million Americans, accounts for 1 million hospitalizations annually, and represents the most common hospital discharge diagnosis for patients over the age of 65. Despite the significant impact of this disease, the accepted approach to treatment of acute decompensated heart failure (ADHF) has changed little in over 40 years. ⋯ This article, the first of a two-part series, will explore the historically accepted disease models for heart failure and their relevance to developing a therapeutic approach to ADHF. Additionally, diagnostic issues in heart failure will be examined, particularly the emerging role of natriuretic peptide assays for the identification of ADHF.
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Randomized Controlled Trial
The effects of the prophylactic tropisetron-propofol combination on postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia.
To evaluate the efficacies of tropisetron and tropisetron-propofol combination in the prophylaxis for postoperative nausea and vomiting in patients undergoing thyroidectomy under desflurane anesthesia. (This combination has apparently not been previously investigated for this particular surgery and anesthesia.) ⋯ The tropisetron-propofol combination is more effective than tropisetron alone in the prevention of postoperative nausea and vomiting after thyroidectomy.