Michael A Sitorius

University of Nebraska Medical Center, Omaha, Nebraska, United States

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Publications (5)14.5 Total impact

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    ABSTRACT: This study evaluates pediatric antidepressant prescribing practices of Nebraska clinicians. Surveys were sent in July, 2005, to 1,521 prescribing clinicians throughout Nebraska to assess pediatric antidepressant use along with any practice changes following the U.S. Food and Drug Administration (FDA) "black box" warning issued in October, 2004. Over half (n = 866) of the clinicians responded to the survey, of which 96.8% reported awareness of the FDA "black box" warning. Of the respondents, 76.9% (n = 666) were prescribing antidepressants to children and/or adolescents. Clinicians reported decreased prescribing frequency for both children (15.5%) and adolescents (36.6%), with 36% having increased referrals to specialists. While 31.9% reported seeing patients more frequently upon initiation of antidepressants, only 7.5% reported weekly visits for the first month of treatment, as recommended by the FDA. Over one fifth (21.9%) reported a caregiver or patient had refused antidepressant medication treatment due to the FDA's warning. Clinicians in Nebraska report changes in clinical practice due to the issuance of the FDA "black box" warning, with a decrease in prescribing antidepressants to pediatric patients and an increase in referrals to specialists. Although awareness of the FDA's warning was evident among clinicians and patients, adherence to recommended guidelines was low.
    Journal of Child and Adolescent Psychopharmacology 03/2008; 18(1):70-80. DOI:10.1089/cap.2007.0049 · 3.07 Impact Factor
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    ABSTRACT: Many primary care physicians find caring for elderly patients difficult. The goal of this study was to develop a detailed understanding of why physicians find primary care with elderly patients difficult. We conducted in-depth interviews with 20 primary care physicians. Using an iterative approach based on grounded theory techniques, a multidisciplinary team analyzed the content of the interviews and developed a conceptual model of the difficulty. Three major domains of difficulty emerged: (i) medical complexity and chronicity, (ii) personal and interpersonal challenges, and (iii) administrative burden. The greatest challenge occurred when difficulty in more than one area was present. Contextual conditions, such as the practice environment and the physician's training and personal values, shaped the experience of providing care and how difficult it seemed. Much of the difficulty participants experienced could be facilitated by changes in the health care delivery system and in medical education. The voices of these physicians and the model resulting from our analysis can inform such change.
    The Gerontologist 01/2003; 42(6):835-42. DOI:10.1093/geront/42.6.835 · 2.48 Impact Factor
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    ABSTRACT: Smoking rates among persons with a history of alcohol abuse are triple that of the general public. Strong evidence indicates that the risk of cancer and cardiovascular disease is higher in recovering alcoholics than in peers who smoke, but do not drink alcohol. Yet these persons often receive less than optimal tobacco counseling out of fear that attempts at smoking cessation will jeopardize their sobriety. Recent research, however, does not support this belief; rather, it suggests that smoking cessation may actually enhance alcohol abstinence. A model for more effective counseling of smokers in recovery is presented, including an algorithm for assessing stages of readiness to change, with activities tailored for each stage. Specific motivational counseling techniques may be useful in encouraging recovering alcoholics to progress to the point that they are ready to change their smoking behavior.
    American family physician 04/1998; 57(8):1869-76, 1879-82. · 1.82 Impact Factor
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    ABSTRACT: A smoker presented with pleuritic chest pain and was found to have reticulonodular interstitial opacities on chest x-ray film. Open lung biopsy revealed changes consistent with histiocytosis X, a disease seen almost exclusively in smokers. Smoking cessation was recommended, and the patient complied. A chest x-ray film taken nearly three years later revealed complete resolution of the radiographic abnormalities. It is proposed that smoking cessation may be related to the improvement in this patient's chest x-ray film findings, and that it should be recommended for all patients with pulmonary histiocytosis X.
    Chest 10/1990; 98(3):765-7. · 7.13 Impact Factor
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    ABSTRACT: To evaluate the smoking cessation efficacy of nicotine patch therapy as an adjunct to low-intensity, primary care intervention. Randomized, placebo-controlled, double-blind, multisite trial. Twenty-one primary care sites in Nebraska. A total of 369 smokers of 20 or more cigarettes per day. Two brief primary care visits for smoking intervention with 10 weeks of active or placebo-patch therapy. Confirmed self-reported abstinence 3, 6, and 12 months after the quit day. Compared with placebo control subjects, participants assigned nicotine patches had higher 3-month (23.4% vs 11.4%; P < .01) and 6-month (18.5% vs 10.3%; P < .05) abstinence rates. The 1-year abstinence rates for the active and placebo patch groups were 14.7% and 8.7%, respectively (P = .07). Of smokers aged 45 years and older, 9 (18.8%) of 48 using active patches compared with 0 of 31 using placebo patches achieved 12-month abstinence (chi 2 = 6.56; P < .05). Among those with high nicotine dependency scores (Fagerstrom score > or = 7), 1-year abstinence rates were significantly higher in the nicotine patch group (19.1%) compared with the placebo group (5.0%) (chi 2 = 10.7; P = .001). However, there was no significant difference in 1-year quit rates for participants with low Fagerstrom scores (< 7). Nicotine patch therapy enhanced 6 month quit rates as an adjunct to brief primary care intervention. The highest quit rates were achieved by participants who specifically contacted the site to enroll in the study or to obtain a prescription for nicotine patches. Differences in participant selection factors may account, in part, for the lower smoking cessation rates associated with primary care intervention. Duration of counseling, patient age, and Fagerstrom scores may be important factors related to the long-term smoking cessation success of nicotine patch therapy.
    Archives of Family Medicine 7(5):425-30.