Journal of adolescent health care : official publication of the Society for Adolescent Medicine
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A national survey of physician fellows in adolescent medicine, a sequel to the 1974-1979 survey, was conducted in 1984. Fifty-one listed programs were identified; 48 directors responded. Two hundred twelve fellows were identified (111 one-year, 101 two-year); 151 (71%) returned the questionnaire. ⋯ Responses as to whether the objective was fully met in each of 18 different content areas showed 60-96% satisfaction in 12 areas but only 23-34% satisfaction in six (developing a research project, participating in a critical assessment of the literature, diagnosing/managing sports medicine, developmental disability, substance abuse problems, and managing pregnancy). Significant differences (p less than 0.05 or less than 0.01) between 1979-1984 fellows compared with the 1974-1979 group included more females, two-year fellows, and fellows in private practice and less fellows in full-time academic work or spending a majority of time in adolescent medicine. These results especially indicate that there are more programs and fellows, more two-year fellows, and suggest more satisfaction with the training experience.
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This study evaluates the effect of physician dress and other variables (i.e., sex of physician and patient, age, and type and site of visit) on patient-physician rapport. Three hundred eighty-six teens filled out a questionnaire, at the end of an office visit, which evaluated their attitudes regarding their physician and their preference for physician dress. ⋯ When asked what they preferred their doctor to wear 43% responded "makes no difference," 26% said "white coat," 14% said "pants and shirt," 10% said "jeans and shirt," and 4% said "suit and tie." Female patients were significantly more comfortable (3.6 versus 3.3, p less than 0.01) with female physicians. Male patients did not show a preference for a same-sex physician.
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Over the past 3 years, toxic shock syndrome (TSS) has emerged from virtual obscurity to become a household word. The syndrome, which most commonly occurs in previously healthy women during menses, is characterized by the sudden onset of headache, malaise, high fever, myalgia, diarrhea, syncope, skin rash, and evidence of multisystem involvement with progression to desquamation of skin, nails, and hair. Death has occurred in 5%-10% of cases. ⋯ Treatment with beta-lactamase-resistant antibiotics and discontinuation of tampon use are associated with reduction in the risk of recurrence. To date, 42% of cases have occurred in females under the age of 19 years. Accordingly, physicians who care for adolescents should be knowledgeable about the syndrome's myriad manifestations and treatment, as well as the possibility of prevention through education about menstrual practices.
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Two cases of severe dyspnea and stridor with upper airway obstruction of obscure origin are discussed. Complete medical evaluation could identify no organic cause for the symptoms, and functional upper airway obstruction was diagnosed. ⋯ Flow-volume loops may show a lower inspiratory vital capacity than expiratory vital capacity and a discrepancy between inspiratory flow limitation and airway resistance. It is important to establish a functional etiology to prevent unnecessary treatment and provide proper care.