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Biomedical subjects

Thomas L Schwenk

Publications and source records attributed to Thomas L Schwenk.

18 recordsLinked to original sources
PubMed2006

Physician experience with family presence during cardiopulmonary resuscitation in children.

OBJECTIVE: Family presence during cardiopulmonary resuscitation in children is an emerging practice. Although many hospitals allow this practice, there is scant research on physician attitudes and opinions and on physician views about training for resident physicians. DESIGN: Survey method. SETTING: University and community settings. PATIENTS: We randomly selected 1,200 pediatric critical care and emergency medicine providers from professional association mailing lists. INTERVENTION: The providers were mailed up to two written surveys and two reminder cards. The survey consisted of 40 multiple-choice and short-answer questions about demographics, past experiences, and opinions on pediatric family presence. MEASUREMENTS AND RESULTS: Of 1,200 surveys mailed, 521 were completed (43.4%) and 73 (6.1%) respondents returned the form declining to participate. More than 99% of respondents were physicians. Four hundred and thirty-three respondents (83%) reported participation in pediatric resuscitation with family members present, with a mean of 15 episodes ever and three episodes within the last year. Of those who had ever participated, more than half thought it was helpful for the family, and two thirds believed that parents wanted the option. Ninety-three percent would allow family presence in some situations. Seventy-four percent believed family presence would be stressful for a resident physician, but nearly 80% believed that residents working with children should be educated in this area. CONCLUSIONS: Family presence during cardiopulmonary resuscitation in children is not an uncommon experience for health care providers. Most respondents had resuscitated a child with family members present. The majority thought that presence was helpful to parents and that residents should be trained in this practice.

Adult↗
PubMed2004

Treatment outcome and physician-patient communication in primary care patients with chronic, recurrent depression.

OBJECTIVE: The authors' goal was to assess the adequacy of control, quality of life, and treatment experiences of patients with chronic, recurrent depression being treated by primary care physicians. METHOD: The sample comprised 1,001 patients 18 years old or older who had chronic, recurring depression and were currently being treated with a single antidepressant prescribed by a primary care physician. These patients had responded positively to questions regarding the presence of clinical depression and prescription of a single antidepressant by a primary care physician during a telephone survey conducted in two stages separated by 18 to 24 months. The 1,001 patients participated in a structured, 20-minute, anonymous interview conducted by trained personnel. RESULTS: Most patients had recurrent depression (median=5 episodes), and most had taken their current antidepressant for more than 1 year. The mean age at onset of depression was 33.8 years, and the mean age at time of diagnosis was 38.0 years, with treatment following a mean of 2 years later. Most patients were satisfied with the care they received from their primary care physician, but many also reported incomplete symptom resolution and substantial side effects from medications that were not discussed with or by their primary care physician. A majority of patients reported that treatment decisions were made in conjunction with their physician, a method that was preferred by three-quarters of the group. Although 752 patients reported that they had mild or moderate depression, 729 were satisfied with their life and 600 said they were in good or excellent health. CONCLUSIONS: Despite being mostly satisfied with the care received from their primary care physician, patients with chronic, recurring depression had substantial levels of continuing dysfunction, distress, unrelieved symptoms, and medication side effects, which suggests several possible physician-centered, patient-centered, or system-centered barriers to treatment to full function and wellness.

Adolescent↗
PubMed2003

Depression and Bipolar Support Alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in late life.

OBJECTIVES: To review progress made during the past decade in late-life mood disorders and to identify areas of unmet need in health care delivery and research. PARTICIPANTS: The Consensus Development Panel consisted of experts in late-life mood disorders, geriatrics, primary care, mental health and aging policy research, and advocacy. EVIDENCE: (1) Literature reviews addressing risk factors, prevention, diagnosis, treatment, and delivery of services and (2) opinions and experiences of primary care and mental health care providers, policy analysts, and advocates. CONSENSUS PROCESS: The Consensus Development Panel listened to presentations and participated in discussions. Workgroups considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed and edited to incorporate input from the entire Consensus Development Panel. CONCLUSIONS: Despite the availability of safe and efficacious treatments, mood disorders remain a significant health care issue for the elderly and are associated with disability, functional decline, diminished quality of life, mortality from comorbid medical conditions or suicide, demands on caregivers, and increased service utilization. Discriminatory coverage and reimbursement policies for mental health care are a challenge for the elderly, especially those with modest incomes, and for clinicians. Minorities are particularly underserved. Access to mental health care services for most elderly individuals is inadequate, and coordination of services is lacking. There is an immediate need for collaboration among patients, families, researchers, clinicians, governmental agencies, and third-party payers to improve diagnosis, treatment, and delivery of services for elderly persons with mood disorders.

Age Factors↗
PubMed2003

Ephedrine and other stimulants as ergogenic aids.

Several recreational, prescription, and illicit drugs have psychotropic effects that may be perceived to be ergogenic. The ephedra alkaloids have received recent attention for their wide use by athletes and their potential serious side effects, despite the lack of evidence regarding any ergogenic or performance benefit. Some prescription drugs (eg, methylphenidate and bupropion) raise complex issues regarding their appropriate therapeutic use in athletes. Recreational drugs, some of which are illegal (eg, cocaine), are commonly used by athletes and cause a wide range of potentially ergolytic effects. In total, these drugs are important for their frequent use, the frequency with which they are mentioned in the media, and their potential for causing significant adverse effects.

Amphetamine↗
PubMed2002

Diagnosis of late life depression: the view from primary care.

In the typical primary care practice, in which patients with a wide range of diseases and symptoms present with numerous needs, concerns, and requests, a chronic disease that lacks quantitative, biologically based diagnostic testing, such as depression, can present a daunting diagnostic challenge to even the best and most dedicated primary care physician. Depression does not compete well for patient and physician time and energy with other medical problems and medical co-morbidity in patients who seek care from their primary care physician. Primary care patients may be more comfortable with and accepting of depression being framed as a "normal" chronic disease rather than a psychiatric "brain" disease subject to cultural and generational stigmas, nihilism, and prejudice. Insurance parity in mental health care would make depression and other mental illness more legitimate in the eyes of patients, family members, employers, and physicians. Of particular value would be new and creative approaches to collaborative care, including telephone monitoring, nurse clinician outreach, and improved availability of psychiatric consultation in primary care, because elderly depressed patients often see the care of their depression as part of the integrated care of multiple chronic medical diseases, rather than a separate psychiatric problem to be referred for specialty care.

Aged↗
PubMed2002

Creatine and other nonsteroidal strength-enhancing aids.

Although most discussions of ergogenic supplements to enhance strength focus on anabolic steroids, there are several nonsteroidal supplements of importance. These agents, including creatine, beta-hydroxy-beta-methylbutyrate (HMB), chromium, human growth hormone, and insulin-like growth factor are popular, easily accessible, sometimes impossible to detect, and (in some cases, ie, creatine) not banned by official sports organizations. They are purported to be natural and safe because they are not anabolic steroids, have at least a theoretic basis for potential benefit, and in some cases, have data suggesting athletic improvement in certain controlled conditions. They also have a significant potential for causing at least bothersome if not dangerous adverse effects. Studies to date have generally addressed efficacy, with little data to support effectiveness in unmonitored, uncontrolled use. Human growth hormone is officially banned. In general, none of these agents can be recommended at present.

Body Composition↗
PubMedDate not supplied

When food becomes a drug: nonanabolic nutritional supplement use in athletes.

The use of nonanabolic nutritional supplements for the sake of improving athletic performance is common, and the types of supplements used can have significant implications for the medical care of athletes. This review will address the most common and most controversial nonanabolic nutritional supplements, including recommendations regarding their use. Many supplements are marketed and promoted based on various theoretical benefits, often derived from limited animal studies, without any basis for recommending their human use. Physicians are trained to not recommend a nutritional supplement unless it is known to be effective, whereas athletes are oriented toward trying any supplement or ergogenic aid as long as it is safe, with the hope that it may be effective. The built-in error in most study designs is larger than the difference between winning and not qualifying at elite levels of competition, such that research may not always answer the questions raised by athletes. An honest discussion of the limitations of most supplements, and acknowledgment that some supplements may work some of the time in some athletes, may lead the physician to be more credible and useful to athletes in providing medical care and guidance that support their desire to improve their performance.

Amino Acids, Branched-Chain↗
PubMedDate not supplied

Adherence to maintenance-phase antidepressant medication as a function of patient beliefs about medication.

PURPOSE: This study aimed to identify the demographic, psychiatric, and attitudinal predictors of treatment adherence during the maintenance phase of antidepressant treatment, ie, after symptoms and regimen are stabilized. METHODS: We surveyed 81 primary care patients given maintenance antidepressant medications regarding general adherence, recent missed doses, depression and treatment features, medication beliefs (necessity, concerns, harmfulness, and overprescription), and other variables. Additional data were collected from medical and payer records. RESULTS: Median treatment duration was 75 weeks. Adherence and beliefs were broadly dispersed and unrelated to treatment duration and type, physical functioning, and demographics. Multivariate analysis adjusting for social desirability, depression severity, and treatment duration indicated that an antidepressant-specific "necessity-minus-concerns" composite was strongly associated with both adherence outcomes. Specifically, adherence was highest when necessity exceeded concerns and lowest when concerns exceeded necessity. We crossed these 2 dimensions to characterize 4 patient attitudes toward antidepressants: skepticism, indifference, ambivalence, and acceptance. CONCLUSIONS: Patients given maintenance antidepressants vary widely in adherence. This variation is primarily explained by the balance between their perceptions of need and harmfulness of antidepressant medication, in that adherence is lowest when perceived harm exceeds perceived need, and highest when perceived need exceeds perceived harm. We speculate on ways to tailor adherence strategies to patient beliefs. Subsequent research should determine whether patients' perceptions about medication predict depression outcomes, can be used to improve clinical management, and respond to behavioral intervention.

Adult↗
PubMedDate not supplied

The Michigan Clinical Research Collaboratory: following the NIH Roadmap to the community.

PURPOSE: This case study describes a successful National Institutes of Health (NIH) Roadmap application that has created a new and innovative translational science partnership at the University of Michigan. METHODS: We describe the institution within which the grant application was developed, the role played by the Department of Family Medicine, the role of prior successes in translational and community-based research, the associated infrastructure development, the application development process, and some features of the final project. RESULTS: A partnership among 2 clinical and research centers of excellence at the University of Michigan, 3 practice-based research networks, and a clinical research center was created as the platform to support an NIH Roadmap. The result was a funded 3.3 million dollar, 3-year project supporting the creation of the Michigan Clinical Research Collaboratory (MCRC), a research infrastructure that will support the design, conduct, and dissemination of community-based clinical translation research. The MCRC depends to a considerable degree on the experience, expertise, and infrastructure in community-based translational research of the Department of Family Medicine. CONCLUSIONS: The successful funding of the MCRC grant will support influential translational research programs of high impact and visibility that would not otherwise have occurred. The MCRC grant is an acknowledgment of the important research to be done in the community, the critical nature of infrastructure investment and prior work in competing successfully for such funding, and the personnel and information technology investments required for success. Collaboration between practice-based family medicine investigators and traditional clinical investigators at the University of Michigan has led to successful competition for an NIH Roadmap grant, which has led in turn to greater institutional recognition for the importance and legitimacy of community-based translational research.

Academic Medical Centers↗