Adolescent medicine: state of the art reviews
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Adolesc Med State Art Rev · Aug 2012
Review Case ReportsAn adolescent evaluated for chronic fatigue: does she have a sleep disorder?
A 13-year-old girl presented to our Division of Adolescent Medicine for evaluation of ongoing fatigue. She and her mother reported that 15 months earlier, when the patient was in the 7th grade, she started to be tired and "sleep all the time." They do not remember her being ill at that time; a test for mononucleosis was reportedly positive, but Epstein-Barr virus titers showed "old disease." She remained fatigued throughout 7th grade but attended school without falling asleep; however, she was too tired to do her work and had to attend summer school. The patient received home instruction in 8th grade and reported that on weekdays she slept from 1 AM to 11 AM with a nap from 4 to 8 PM and on weekends she slept from 3 AM to 1 PM without a nap.
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Adolesc Med State Art Rev · Apr 2012
ReviewFertility preservation for adolescent women with cancer.
As the cure rate for adolescents with cancer has improved, the focus on future reproductive potential has increased. Despite a concerted effort to reduce the impact of cancer treatment on fertility through the alteration of therapy and the implementation of protective measures, many adolescent women with cancer remain at risk for impaired reproductive potential. Although the only standard-of-care approach to fertility preservation in this population remains embryo cryopreservation, there has been intense development of oocyte and ovarian cryopreservation as viable alternatives. This article focuses on the developing modalities of fertility preservation for adolescent women diagnosed with cancer.
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Adolesc Med State Art Rev · Dec 2011
ReviewClinical approaches to improving alcohol education and counseling in adolescents and young adults.
Clinical prevention trials (approaches to educating and counseling) of adolescents (teens and young adults aged 12 to 25) about risks related to alcohol use indicate that reduction in adolescent alcohol use is possible with nonphysicians as interventionists and physicians as interventionists supported by patient counseling guides and resources. Opportunities for personalized, interactive adolescent education with goal setting appears key to intervention success. Physicians might also be more effective if they are aware of emerging alcohol problems among youth, systems-level resources for counseling adolescents about prevention, and appropriate guidance for parents. Recommendations and resources for clinicians working with adolescents regarding alcohol misuse are provided.
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Adolesc Med State Art Rev · Aug 2011
Treatment of anorexia nervosa against the patient's will: ethical considerations.
By the nature of their illness, many if not most patients with anorexia nervosa are treated against their will. This article explores the issue of patient autonomy and right to treatment refusal in the light of justified paternalism as well as a more enriched understanding of autonomy in the context of relationships. A summary follows on the research on patients' perceptions and response to involuntary treatment. The conclusion addresses the importance of human values intrinsic to the quality of a clinical relationship as determinant for patient recovery and professional satisfaction.
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This article describes iatrogenic events, giving examples that range from individual error to systemic malfunctions. It then goes on to analyze individual and system responsibilities in the disclosure of iatrogenic events. A discussion follows on the physician's responsibility, professional integrity, "duty to warn", and transparency as they relate to error disclosure, including an examination of the role of apology and repair in the setting of iatrogenesis. It concludes by considering the moral and legal operational implications of iatrogenic events and the building of a culture of safety.