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Biomedical subjects

H M Swick

Publications and source records attributed to H M Swick.

At least 19 recordsLinked to original sources
PubMed2001

Professionalism: a key to weathering the storm.

The President's Program at the 2000 Annual Clinical Meeting of ACOG addressed the question of how best to maintain professional values in the current, market-driven health care environment. The author's presentation during that presidential program provided the basis of this article. In today's corporate environment, the distinction between the practice of medicine and the business of medicine has become blurred. Too often, market values prevail over traditional professional values. As a consequence, physicians face increasing challenges and frustrations. To ease the discomfort of practicing in a new corporate age, physicians must maintain medical professionalism and hence reassert the primacy of professional values in caring for patients. Individually, physicians must exercise professionalism in their roles as educators and practitioners. Collectively, the profession of medicine must exercise professionalism by advocating patients' interests and by accepting accountability for both long-established and emerging obligations that physicians have to their patients and to society.

Ethics, Medical↗
PubMed2000

Toward a normative definition of medical professionalism.

In recent years, professionalism in medicine has gained increasing attention. Many have called for a return to medical professionalism as a way to respond to the corporate transformation of the U.S. health care system. Yet there is no common understanding of what is meant by the word professionalism. To encourage dialog and to arrive eventually at some consensus, one needs a normative definition. The author proposes such a definition and asserts that the concept of medical professionalism must be grounded both in the nature of a profession and in the nature of physicians' work. Attributes of medical professionalism reflect societal expectations as they relate to physicians' responsibilities, not only to individual patients but to wider communities as well. The author identifies nine behaviors that constitute medical professionalism and that physicians must exhibit if they are to meet their obligations to their patients, their communities, and their profession. (For example, "Physicians subordinate their own interests to the interests of others.") He argues that physicians must fully comprehend what medical professionalism entails. Serious negative consequences will ensue if physicians cease to exemplify the behaviors that constitute medical professionalism and hence abrogate their responsibilities both to their patients and to their chosen calling.

Clinical Competence↗
PubMed1999

Teaching professionalism in undergraduate medical education.

CONTEXT: There is a growing consensus among medical educators that to promote the professional development of medical students, schools of medicine should provide explicit learning experiences in professionalism. OBJECTIVE: To determine whether and how schools of medicine were teaching professionalism in the 1998-1999 academic year. DESIGN, SETTING, AND PARTICIPANTS: A 2-stage survey was sent to 125 US medical schools in the fall of 1998. A total of 116 (92.3%) responded to the first stage of the survey. The second survey led to a qualitative analysis of curriculum materials submitted by 41 schools. MAIN OUTCOME MEASURES: Presence or absence of learning experiences (didactic or experiential) in undergraduate medical curriculum explicitly intended to promote professionalism in medical students, with curriculum evaluation based on 4 attributes commonly recognized as essential to professionalism: subordination of one's self-interests, adherence to high ethical and moral standards, response to societal needs, and demonstration of evincible core humanistic values. RESULTS: Of the 116 responding medical schools, 104 (89.7%) reported that they offer some formal instruction related to professionalism. Fewer schools have explicit methods for assessing professional behaviors (n = 64 [55.2%]) or conduct targeted faculty development programs (n = 39 [33.6%]). Schools use diverse strategies to promote professionalism, ranging from an isolated white-coat ceremony or other orientation experience (n = 71 [78.9%]) to an integrated sequence of courses over multiple years of the curriculum (n = 25 [27.8%]). Of the 41 schools that provided curriculum materials, 27 (65.9%) addressed subordinating self-interests; 31 (75.6%), adhering to high ethical and moral standards; 17 (41.5%), responding to societal needs; and 22 (53.7%), evincing core humanistic values. CONCLUSIONS: Our results suggest that the teaching of professionalism in undergraduate medical education varies widely. Although most medical schools in the United States now address this important topic in some manner, the strategies used to teach professionalism may not always be adequate.

Clinical Competence↗
PubMed1998

Academic medicine must deal with the clash of business and professional values.

Academic medicine faces unprecedented challenges, especially the impact of the changing and more business-oriented health care system on medical education. There is an inherent clash of values between business and medicine: among key business values are profit and competition, while among the traditional values of the medical profession are service, advocacy, and altruism. Business interests have already gained a central place in medicine, so the challenge has become how to utilize the positive elements of the entrepreneurial spirit to enhance professional values and advance academic medicine's central enterprise. The author maintains that to achieve that synthesis, the leaders of academic medicine must continue to engage in a dialogue with the broader academic community, the government, the public, and the health care industry. The dialogue must emphasize (1) managing change rather than resisting it (such as focusing on the positive aspects of change, keeping sight of the fundamental professional values of medicine and medical education, and maintaining cool, rational judgment in the face of challenges); (2) making academic medicine's case with many constituencies, such as the health care industry, government, and the public; and (3) fostering professionalism by increasing medical schools' emphasis on this task, by ensuring that schools keep an appropriate balance between the science and the art of medicine, and by having faculty model appropriate professional values for their students. The author concludes that while change inevitably brings challenge and a sense of loss, it also brings the opportunity to help reshape medical education to meet the needs of society.

Academic Medical Centers↗
PubMed1992

Glycemic control and peripheral nerve conduction in children and young adults after 5-6 mo of IDDM. Wisconsin Diabetes Registry.

OBJECTIVE: A cohort of people (n = 86) was examined in the first few months after insulin-dependent diabetes mellitus (IDDM) diagnosis to evaluate the effect of hyperglycemia on nerve conduction velocities and latencies. RESEARCH DESIGN AND METHODS: Unselected cases with IDDM, who were 6-29 yr of age, were identified at diagnosis from a large, geographically defined area of southern Wisconsin. Peripheral nerve conduction was measured on a sample from this cohort. RESULTS: Peroneal nerve conduction velocity was significantly inversely related to glycosylated hemoglobin (P less than 0.05, age and height adjusted). All other nerve conduction velocities and latencies (median motor, median sensory, and sural) showed the same tendency, but the associations were not statistically significant. Twenty-four-hour urine C-peptide and duration of diabetes (3-11 mo) were not consistently related to nerve conduction parameters after controlling for age and height. CONCLUSIONS: These findings suggest that as early as 5-6 mo after diabetes diagnosis, and at a time frequently characterized by partial remission of IDDM, hyperglycemia has a role in the acute slowing of nerve conduction velocity. Other factors such as residual endogenous insulin production do not appear to influence these early changes.

Adolescent↗
PubMed1991

Role of height and glycosylated hemoglobin in abnormal nerve conduction in pediatric patients with type I diabetes mellitus after 4-9 yr of disease.

OBJECTIVE: To determine the role of height and glycosylated hemoglobin in abnormal nerve conduction in pediatric patients with insulin-dependent (type I) diabetes mellitus. RESEARCH DESIGN AND METHODS: Sixty-six pediatric patients (aged 6.3-18.2 yr) with a duration of diabetes from 4 to 8.5 yr but free of clinical neuropathy were evaluated for abnormal nerve conduction. RESULTS: Mean HbA1 values for 1 and 2 yr before study were available. Electroneurographic findings were significantly different from control subjects in upper and lower extremities and included all five measured velocities, three sensory latencies, and one amplitude. Stepwise regression analysis identified an adverse effect of height on latency (5 of 6) and of mean HbA1 concentration on decreasing velocity (4 of 5). The data analysis from 52 patients who were restudied and who had a duration of diabetes from 5.3 to 9.6 yr confirmed that all velocity values slowed; one of five values did so significantly. The coefficients associated with mean HbA1 concentration usually increased in both upper- and lower-extremity velocity analyses at the follow-up examination. The change in peroneal motor velocity between the first and last examinations was significantly related to the increasing time interval between examinations. CONCLUSIONS: Prospective evaluation of nerve conduction parameters in pediatric patients with diabetes should include both height (the most significant independent variable in latency analysis) and mean glycemic control (the most consistent variable in velocity analyses) as variables in the assessment of the natural history of evolving peripheral neuropathy.

Body Height↗
PubMed1988

Intrathecal administration of iopamidol in children: clinical and diagnostic results.

An open label, noncomparative clinical trial of intrathecal iopamidol in children was performed. Sixty-one subjects between the ages of 24 days and 17 years were studied. Opacification of the subarachnoid space was adequate in all cases. Mild adverse reactions were detected in 10% of the participants. Seizures, EEG alterations or other severe reactions did not occur. The findings confirm the efficacy and safety of iopamidol as an intrathecal contrast medium in pediatrics.

Adolescent↗
PubMed1987

A model clinical neuroscience curriculum.

We have attempted to identify those attitudes, skills, and competencies in the clinical neurosciences that every graduating medical student should possess. Curricular guidelines are provided that may act as a model educational outline, to be adapted and utilized as individual circumstances dictate and resources permit. A universal, although not lockstep, curriculum emerges from these considerations.

Curriculum↗
PubMed1987

Comparison of Duchenne and normal myoblasts from a heterozygote.

To test the hypothesis that the Duchenne muscular dystrophy gene limits the proliferation of myoblasts, we studied myoblasts from a woman who was a carrier of the Duchenne gene and also heterozygous for glucose-6-phosphate dehydrogenase (G6PD), an X-linked enzyme. G6PD-A and G6PD-B cells did not differ in proliferative capacity, implying no difference in proliferative capacity of cells bearing the Duchenne gene or the normal allele.

Cell Separation↗
PubMed1986

Neurological involvement in hemolytic-uremic syndrome.

Of 44 children with hemolytic-uremic syndrome seen at Milwaukee Children's Hospital, 15 (34%) had neurological involvement. This group contained 8 boys and 7 girls, with a mean age of 3 1/4 years. Twelve patients had seizure within 48 hours of admission. Seizures were associated with hypertension, fever, hyponatremia, or hypocalcemia. Other neurological symptoms included altered consciousness, behavioral changes, diplopia, and dizziness. Hemiparesis (4 patients), eye involvement (7 patients), decerebrate posturing (2 patients), and ataxia (1 patient) were present on physical examination. Cerebrospinal fluid examination showed increased protein in 4 of 11 patients. Electroencephalograms were abnormal in all 9 patients tested. Computed tomographic and radionuclide scans showed evidence of vascular abnormalities in 4 of the 14 patients studied. Complete neurological recovery occurred in only 6 of the 15 children, while the remaining 6 demonstrated residual hemiparesis, seizures, and cortical visual defect. In those children with neurological involvement, there was a higher incidence of residual hypertension (49% versus 11%), chronic renal damage (40% versus 3.5%), and death (28% versus 0%), suggesting that central nervous system involvement indicates severe hemolytic-uremic syndrome.

Anticonvulsants↗
PubMed1983

Congenital fibre type disproportion with unusual clinico-pathologic manifestations.

Two cases with congenital fibre type disproportion are presented. The cases are unusual in that there were significant dysmorphic features in case 1, and both cases showed electromyographic abnormalities suggestive of denervation. A third case, the father of the second patient, showed clinical features of congenital fibre type disproportion in early life but later developed the rigid spine syndrome. The spinal cord of case 3 showed atrophy and degeneration of medial neuronal group in the lumbosacral segments. The clinical and pathological features in these cases further extend the view that congenital fibre type disproportion may be seen in a variety of patients.

Adult↗
PubMed1981

Pharyngoesophageal motor function in patients with myotonic dystrophy.

Six adults with myotonic dystrophy underwent detailed radiological and manometric studies of pharyngoesophageal function. Four of the patients had no history of swallowing dysfunction, while two had very mild symptoms. All patients showed abnormalities of pharyngoesophageal function. Pharyngeal peristalsis was present but of low amplitude. Resting upper esophageal sphincter pressure was diminished, but the sphincter relaxed normally. Peristalsis in the esophageal body was invariably absent in the striated muscle segment of the esophagus and was either absent of decreased in amplitude in the smooth muscle segment. The lower esophageal sphincter was normal. Myotonia did not occur in the sphincters or the esophageal body. These findings suggest that pharyngoesophageal dysfunction is common in patients with myotonic dystrophy, even when clinical symptoms are absent. The abnormalities are probably related to muscle weakness rather than to myotonia in the pharyngeal and esophageal musculature.

Adult↗
PubMed1981

Brucella meningoencephalitis in childhood.

An 11-year-old girl developed a subacute illness characterized by fever, malaise, depression, and meningoencephalitis. The etiology remained elusive until her agglutinin titer against Brucella abortus rose from 1:20 to 1:320. Brucellosis is an uncommon illness in children, an neurological involvement has been described in only ten cases. Brucella meningoencephalitis is characterized by a lymphocytic pleocytosis and elevated protein in the cerebrospinal fluid. Patients respond well to specific therapy; it is important, therefore, to consider the diagnosis of brucellosis in patients with subacute meningitis of unexplained etiology.

Antibodies, Bacterial↗
PubMed1981

Imaging the intracranial complications of Hemophilus influenzae meningitis.

Computed tomography (CT) and radionuclide imaging of the central nervous system (CNS) are important modalities in both the diagnosis and management of CNS complications from Hemophilus influenzae meningitis. Both examinations are sensitive indicators of CNS abnormalities associated with bacterial meningeal infections and are important determinants of the therapy and ultimate prognosis of such complications. Representative findings from CT and radionuclide imaging of children with complications from H. influenzae infection of the meninges are presented.

Brain↗
PubMed1981

Valproic acid and secondary hyperammonemia.

An 11-year-old girl with complex seizures was started on valproic acid (VPA) in addition to clonazepam and ethosuximide. Shortly thereafter, she developed marked hyperammonemia that was worsened by a protein load. The hyperammonemia improved somewhat when protein was not given, and it resolved on discontinuation of the valproic acid. No associated changes in serum transaminases or bilirubin were observed. Isolated hyperammonemia may occur soon after VPA ingestion and appears to be a relatively infrequent, reversible side effect. The mechanism of hyperammonemia probably differs from other manifestations of hepatotoxicity, such as elevated transaminases or frank hepatic failure.

Ammonia↗
PubMed1980

Pediatric metrizamide ventriculography.

Although computerized cranial tomography (CT) is useful for the diagnosis of hydrocephalus and various fluid-containing intracranial cysts. CT cannot always define the functional relationship of the cyst to the normal CSF pathways. In such cases, ventriculography may be necessary to determine proper treatment. Metrizamide, a nonionic water-soluble contrast medium, has been used for myelography and ventriculography in adults and for myelography in children. Eleven children have been ventriculograms using metrizamide with conventional roentgenographic techniques. Diagnostic information was obtained in all but one study. No major complications occurred.

Adult↗