T Bravender

Harvard Medical School, Boston, Massachusetts, United States

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Publications (10)27 Total impact

  • Journal of Adolescent Health 05/2000; 26(4):241-2. · 2.97 Impact Factor
  • Journal of Adolescent Health 01/2000; 26(4):241-242. · 2.97 Impact Factor
  • Journal of Adolescent Health - J ADOLESCENT HEALTH. 01/2000; 26(4):241-242.
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    ABSTRACT: To determine the teaching methods, materials currently used, and unmet needs for teaching developmental-behavioral pediatrics (DBP) at pediatric training programs in the United States. Cross-sectional survey of US pediatric residency training programs. The survey questionnaire consisted of 3 instruments: a program director survey, a developmental-behavioral pediatrics survey, and an adolescent medicine survey. Survey packets were mailed in January 1997 to 211 programs identified by mailing labels from the Association of Pediatric Program Directors. Data from 148 programs (70%) completing both the DBP survey and program director survey were analyzed. Ninety-five percent of programs reported a block rotation, and 95% of those stated that the rotation was mandatory. Eighty-seven percent had a formal curriculum. Most programs reported using articles, lecture outlines, and precepting for teaching DBP. Few programs used standardized case-based or computerized materials. Most programs, however, indicated a desire for these materials. Few programs felt that 4 topics were covered adequately: adoption (12%), violence (24%), substance use (28%), and conduct problems (41%). Programs that perceived that they covered these topics adequately were more likely to use written cases as part of their curriculum (Mann-Whitney test, 1373.5; P=.04). Barriers to teaching included lack of adequate faculty, time, money, and curricular resources. Pediatric residency programs have made significant gains in mandatory DBP training. However, many programs report a lack of adequate faculty, teaching materials, and methods. Responding programs indicated an interest in case-based materials. This approach may represent an alternative and underutilized resource for teaching DBP.
    Archives of Pediatrics and Adolescent Medicine 12/1999; 153(11):1190-4. · 4.28 Impact Factor
  • T Bravender, S J Emans, M R Laufer
    Archives of Pediatrics and Adolescent Medicine 08/1999; 153(7):773-4. · 4.28 Impact Factor
  • T Bravender, S J Emans
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    ABSTRACT: Dysfunctional uterine bleeding is defined as abnormal endometrial bleeding without structural pathology. Although, abnormal uterine bleeding may occur in women of all ages, it is a particularly common issue for adolescents. This article reviews the normal menstrual cycle and the abnormal menstrual cycles. Familiarity with the normal menstrual cycle is necessary to identify the possible causes of abnormal bleeding and aids in the diagnosis and treatment of patients with abnormal uterine bleeding.
    Pediatric Clinics of North America 07/1999; 46(3):545-53, viii. · 1.78 Impact Factor
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    ABSTRACT: We sought to examine possible differences in medical status at presentation in 1996, compared to 1991, of adolescents with eating disorders (EDs) at a hospital-based multidisciplinary care program to reflect the increasing market penetration of managed care. Charts were reviewed for all new patients scheduled in a hospital-based outpatient ED program in 1996 and 1991. The 92-item standardized data extraction form included information on demographics, indicators of illness severity at the first visit, and subsequent hospitalization. The need for primary care referral was verified using billing records. Data were analyzed with Student's t-test, Chi-square, Fisher's exact, and Mann-Whitney U tests using SPSS 7.5. Of the 153 total patients, 133 kept their intake appointment and 130 (98%) of these had charts available for review. The age, racial/ethnic characteristics, and average length of disordered eating behaviors were not significantly different over the 5-year period. Referral from a primary care clinician was more commonly required in 1996 than 1991 (59% vs. 11%; p < .0001). Eighteen percent of the patients seen in 1996 were admitted from the initial appointment for medical stabilization, compared to 1.5% in 1991 (p = .002). Comparing 1996 to 1991, a similar number of patients had symptoms consistent with anorexia nervosa, whereas fewer patients in 1996 gave a history of bingeing and purging (22% vs. 40%; p = .027). There were no significant differences in indicators of illness severity, treatment by primary care clinician prior to referral, or hospitalization rates for those patients with and without managed care. Patients in 1996 were more likely to require referrals, were less likely to have symptoms consistent with bulimia nervosa, and were more likely to be admitted for medical stabilization. There were no differences in patient presentation characteristics or initial hospitalization rates based on their managed care status. Further research is needed to investigate the changes in illness severity at presentation and to assess the role that managed care plays in the treatment of patients with eating disorders.
    Journal of Adolescent Health 06/1999; 24(6):422-6. · 2.97 Impact Factor
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    ABSTRACT: To determine how pediatric residency programs are responding to the new challenges of teaching adolescent medicine (AM) to residents by assessing whether manpower is adequate for training, whether AM curricula and skills are adequately covered by training programs, what types of teaching methodologies are used to train residents in AM, and the needs for new curricular materials to teach AM. A 3-part 92-item survey mailed to all US pediatric residency training programs. Pediatric residency programs. Residency program directors and directors of AM training. AM divisional structure, clinical sites of training, presence of a block rotation, and faculty of pediatric training programs; training materials used and desired in AM; perceived adequacy of coverage of various AM topics; competency of residents in performing pelvic examinations in sexually active teens; and manpower needs. A total of 155/211 (73.5%) of programs completed the program director and the AM parts of the survey. Ninety-six percent of programs (size range, 5-120 residents) had an AM block rotation and 90% required the AM block; those without a block rotation were more likely to be larger programs. Only 39% of programs felt that the number of AM faculty was adequate for teaching residents. Almost half of the programs reported lack of time, faculty, and curricula to teach content in substance abuse. Besides physicians, AM teachers included nurse practitioners (28%), psychologists (25%), and social workers (19%). Topics most often cited as adequately covered included sexually transmitted diseases (81.9%), confidentiality (79.4%), puberty (77.0%), contraception (76.1%), and menstrual problems (73.5%). Topics least often cited as adequately covered included psychological testing (16.1%), violence in relationships (20.0%), violence and weapon-carrying (29.7%), and sports medicine (29.7%). Fifty-eight percent of 137 respondents thought that all or nearly all of their residents were competent in performing pelvic examinations by the end of training; there was no difference between perceived competence and the residents' use of procedure books. Seventy-four percent used a specific curriculum for teaching AM; materials included chapters/articles (85%), lecture outlines (76.1%), slides (41.9%), videos (35.5%), written case studies (24.5%), computerized cases (6.5%), and CD-ROMs (3.2%). Fifty-two percent used Bright Futures, 48% used the Guidelines for Adolescent Preventive Services, and 14% used the Guide to Clinical Preventive Services for teaching clinical preventive services. Programs that used Bright Futures were more likely to feel that preventive services were adequately covered in their programs than those who did not (78% vs 57%). A majority of programs desired more learner-centered materials. Although almost all pediatric programs are now providing AM rotations, there is significant variability in adequacy of training across multiple topics important for resident education. Programs desire more learner-centered materials and more faculty to provide comprehensive resident education in AM.
    Pediatrics 10/1998; 102(3 Pt 1):588-95. · 5.12 Impact Factor
  • T Bravender, J R Knight
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    ABSTRACT: Addressing adolescent substance abuse presents a tremendous challenge to the practicing clinician. Despite ongoing educational and preventive services, and despite increasing governmental interdiction, substance use by adolescents continues to be a major national problem. Although present rates of use are lower than the peak rates in the late 1970s, drug use among adolescents nearly doubled in the early 1990s and is a significant cause of morbidity and mortality. Patterns of use continue to evolve. Newer drugs make their way to the streets, and older drugs are rediscovered. Behavioral and environmental factors increase the risk for adolescent substance abuse. Identification of use patterns and familiarity with comorbid behaviors and social risks may help the clinician identify the adolescent at risk.
    Current Opinion in Pediatrics 09/1998; 10(4):344-9. · 2.63 Impact Factor