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David S Rosen

Publications and source records attributed to David S Rosen.

At least 19 recordsLinked to original sources
PubMed2005

The treatment of adolescent depression in the era of the black box warning.

PURPOSE OF REVIEW: This paper reviews the epidemiology and sequelae of adolescent depression, recent studies of antidepressants and psychotherapeutic modalities for treatment of adolescent depression, and the black box warning from the United States Food and Drug Administration regarding the use of antidepressants in adolescents. RECENT FINDINGS: Over the past 4 years, four major randomized placebo-controlled trials of selective serotonin reuptake inhibitors in adolescents have been published. Although each of these published studies concluded that the drug under study was efficacious, the United States Food and Drug Administration and others have offered words of caution. Over the past 2 years, there has been increasing concern that antidepressants may increase suicidal thinking and behavior (not completed suicide) in depressed adolescents. The United States Food and Drug Administration has issued a black box warning asking providers to use caution when prescribing antidepressants in children under the age of 18. SUMMARY: Adolescent depression is common, socially and economically costly, and a potentially lethal disease. Recent studies of antidepressant use in adolescents have demonstrated variable efficacy and an increased risk of adverse events, including suicidality. The evidence is greatest to support the efficacy of fluoxetine, and thus it remains the only selective serotonin reuptake inhibitor approved by the United States Food and Drug Administration for the treatment of depression in children and adolescents. Psychotherapy is strongly encouraged in any patient for whom medication is prescribed. The risk of adverse events associated with antidepressant use requires caution when these medications are prescribed to adolescents. In an adolescent with depression, however, there is an inherent and greater risk to doing nothing.

Adolescent↗
PubMed2005

Subarachnoid hemorrhage grading scales: a systematic review.

Numerous systems are reported for grading the clinical condition of patients following subarachnoid hemorrhage (SAH). The literature was reviewed for articles pertaining to the grading of such patients, including publications on the Hunt and Hess Scale, Fisher Scale, Glasgow Coma Score (GCS), and World Federation of Neurological Surgeons Scale. This article reviews the advantages and limitations of these scales as well as more recent proposals for other grading systems based on these scales with or without addition of other factors known to be prognostic for outcome after SAH. There remain substantial deficits in the literature regarding grading of patients with SAH. Most grading scales were derived retrospectively, and the intra- and interobserver variability has seldom been assessed. Inclusion of additional factors increases the complexity of the scale, possibly making it less likely to be adopted for routine usage and increasing (only marginally in some cases) the ability to predict prognosis. Until further data are available, it is recommended that publications on patients with SAH report at least the admission GCS as well as factors commonly known to influence prognosis, such as age, pre-existing hypertension, the amount of blood present on admission computed tomography, time of admission after SAH, aneurysm location and size, presence of intracerebral or intraventricular hemorrhage, and blood pressure at admission.

Age Factors↗
PubMed2004

Sexually transmitted infections in adolescents: practical issues in the office setting.

The office-based clinician has an important role in preventing, diagnosing, and treating STIs in adolescents. Primary-care guidelines consistently recommend the annual screening of adolescents for sexual activity and its sequelae. Appropriate office-based care of adolescents requires a firm understanding of adolescent confidentiality laws as well as sensitivity to the adolescent's need for privacy. Counseling should be provided regarding abstinence, the use of condoms, and the value of dual contraception. Newer screening methods, such as the use of urine samples and nucleic-acid amplification techniques, may facilitate appropriate office-based screening for STIs in adolescent patients.

Adolescent↗
PubMed2004

Transition of young people with respiratory diseases to adult health care.

As many more young people with chronic health conditions survive well into adulthood, transition of affected young people from paediatric to adult health care is increasingly becoming the expected standard of care. Despite this, there is still little objective or long-term evidence to guide the development or deployment of developmentally appropriate transition processes or to define the precise manner in which the transfer of care should take place. Nevertheless, certain principles of transition have now received nearly universal endorsement. In this paper, the rationale for transition is discussed, practical strategies for transition are described, the existing evidence base supporting transition is reviewed and limitations in our knowledge are outlined. Ultimately, a carefully planned transition to adult health care should improve self-reliance, enhance autonomy and independence and support young people in attaining their maximum potential and meaningful adult lives.

Adolescent↗
PubMed2004

Grading of subarachnoid hemorrhage: modification of the world World Federation of Neurosurgical Societies scale on the basis of data for a large series of patients.

OBJECTIVE: The goals of this study were to use a large, prospectively collected, multicenter database for patients with aneurysmal subarachnoid hemorrhage (SAH) who were treated between 1991 and 1997 to determine the prognostic significance of clinical and radiological factors for outcomes and to use those factors to develop a grading scale to predict outcomes. METHODS: A total of 3567 patients with SAH who were entered into four randomized clinical trials of tirilazad were studied. Outcomes were assessed 3 months after SAH, with the Glasgow Outcome Scale. Twenty clinical and radiological factors were entered into univariate and multivariate analyses, to determine factors prognostic for outcomes. Grading scales based on the most powerful prognostic parameters were statistically derived and validated and were compared with the World Federation of Neurosurgical Societies (WFNS) grading scale. RESULTS: Factors predictive of outcomes included age, WFNS grade, history of hypertension, systolic blood pressure at admission, ruptured aneurysm location and size, blood clot thickness on computed tomographic scans, and angiographic vasospasm at admission. A grading scale using these factors could be derived; it predicted outcomes more accurately than did the WFNS scale, although it would be more complex to use. CONCLUSION: Outcome prediction after SAH can be improved by adding additional clinical and radiological factors to the WFNS scale, albeit with added complexity.

Adolescent↗
PubMed2003

Recurrence of symptoms after Chiari decompression and duraplasty with nonautologous graft material.

Nonautologous material is commonly used for dural grafting. Although good results have been reported with the use of some of these materials in cranial surgery, there is a paucity of information regarding their use in craniocervical decompressive surgery. We report three cases of patients with Chiari malformation type I who experienced recurrent or new-onset Chiari symptoms after surgical decompression and duraplasty with bovine pericardium, Gore-Tex or cadaveric dura. We review the use of these materials and propose possible mechanisms by which a reaction to a nonautologous graft could cause recurrent Chiari symptoms. The preferential use of autologous material for dural grafts during posterior fossa decompressive surgery should prevent this cause of symptom recurrence.

Adult↗
PubMed2003

Children and adolescents with eating disorders: the state of the art.

BACKGROUND: Eating disorders in children and adolescents remain a serious cause of morbidity and mortality in children, adolescents, and young adults. The working knowledge of pathophysiology, recognition, and management of eating disorders continues to evolve as research in this field continues. OBJECTIVES: This article builds on previous background and position papers outlining issues relevant to the care of the adolescent patient with an eating disorder. METHODS: The eating disorder special interest group from the Society for Adolescent Medicine recognized the need to update the state of the art published guidelines for the care of the adolescent patient with an eating disorder. This article was a multidisciplinary, group effort to summarize the current knowledge of best practice in the field. RESULTS: This article summarizes newer findings on pathogenesis and etiology, prevention and screening, risk factors, nutritional issues, care from the primary care clinician's perspective, appropriate use of a multidisciplinary team, and issues of managed care and reimbursement. CONCLUSIONS: Primary prevention combined with early recognition and treatment helps decrease morbidity and mortality in adolescents with eating disorders.

Adolescent↗
PubMed2003

Eating disorders in children and young adolescents: etiology, classification, clinical features, and treatment.

Eating disorders in children and young adolescents are increasing in prevalence and occurring at ever-earlier ages. Eating disorders in this age group differ from the traditional eating disorders seen in older adolescents and young adults in that they frequently present atypically, they are suspected less often, they are more difficult to diagnose definitively, and there is less evidence to guide informed treatment decisions. Classification of eating disorders in this population also presents unique challenges. A high index of suspicion and aggressive screening will help to prevent delays in diagnosis. Treatment should include attention to nutritional, medical, and psychological issues. Family therapy has emerged as the treatment modality with the greatest evidence for its efficacy. Prognosis has been poorly studied, but good outcomes are common, particularly with early intervention.

Adolescent↗