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Biomedical subjects

John F Wilson

Publications and source records attributed to John F Wilson.

At least 37 records · Page 2Linked to original sources
PubMed2003

Childhood and adolescent large-cell lymphoma (LCL): a review of the Children's Cancer Group experience.

We reviewed the clinical characteristics, treatment, and outcome of 67 children with localized and 212 with disseminated large-cell lymphoma (LCL) treated during a 20-year period in 5 consecutive Children's Cancer Group (CCG) non-Hodgkin's lymphoma (NHL) trials. Clinical outcomes for patients treated on the four earlier studies with moderate-dose chemotherapy administered over 12-18 months were compared with patients treated most recently with short, intensive therapy. Median age at diagnosis was 12 years (range: 0-19 years). Male to female ratio was 1.8:1.0. Five-year event-free survival (EFS) was 92% +/- 3.3% and 50 +/- 3.5% for patients with localized LCL and disseminated LCL, respectively. After adjustment for lactate dehydrogenase (LDH), age at diagnosis, and BM involvement, short and intensive therapy as delivered on the most recent study, CCG-5911, was associated with an improved outcome (P< 0.05) compared to the four previous studies. Elevated LDH (> or = 500 IU/L) at diagnosis and young age (<5 years) were both significant independent predictors of poorer long-term EFS (P< 0.05). Long-term survival after relapse or other treatment failure was only 31% +/- 4.7%. In summary, more recent shorter and intense therapy appears to be associated with superior event-free survival for children and adolescents with disseminated LCL. Large numbers of patients treated with shorter and intense therapy are required to confirm these preliminary observations.

Adolescent↗
PubMed2003

Clinical skills as demonstrated by a comprehensive clinical performance examination: who performs better - men or women?

PURPOSE: Determine whether gender predicted student performance on a clinical performance examination (CPX) when controlling for pre-matriculation and medical school performance. METHOD: A sixteen-station CPX, utilizing standardized patients (SPs), was administered to the fourth-year students three successive years at one United States medical school. Scores for each student by discipline and skills across stations were generated. Bivariate correlation and multiple regression analyses were performed to determine relationships between students' scores and pre-matriculation information (age, gender, MCAT, and undergraduate GPA) and medical school performance (first-, second- and third-year GPA, and USMLE Step 1). RESULTS: The CPX mean score for all students was 65.1% (SD 6.2). The mean total score for men (n = 182) and women (n = 93) was 64.0% and 67.0%, respectively. Being a woman, positively affected a student's score in two models controlling for pre-matriculation and medical school performance by 2.8% or 0.47 standard deviations (SD) and 2.3% or 0.39 SD, respectively. Women scored numerically higher than men in all seven disciplines (internal medicine, obstetrics/gynecology, pediatrics and psychiatry, p < 0.05) and for nine skills across all stations (introduction, history, physical examination, counseling and interpersonal, p < 0.05). CONCLUSION: Women performed better than men on the University of Kentucky CPX. Being a woman was a positive and independent predictor of performance.

Adult↗
PubMed2003

Burkitt's and Burkitt-like lymphoma in children and adolescents: a review of the Children's Cancer Group experience.

Historically, the survival of children and adolescents with Burkitt's and Burkitt-like lymphoma had been poor. Recently, short and intensive chemotherapy appears to have improved disease outcome. We therefore reviewed the results of four successive Children's Cancer Group trials conducted on 470 children with disseminated Burkitt's and Burkitt-like lymphoma. Of the patients studied, the median age was 8 years (0-21 years), the male:female ratio was 4:1, 58% had lactate dehydrogenase (LDH) > or = 500 IU/l, 23% had M2 or M3 bone marrow (BM), and 12% demonstrated central nervous system involvement. In a multivariate analysis, the 4-year event-free survival (EFS) in patients > or = 15-years-old compared with < 15-year-old was 34 +/- 7 versus 59 +/- 2% (P < 0.05), the 4-year EFS of M2/M3 compared with M1 BM was 38 +/- 5 versus 63 +/- 3% (P < 0.001), and the 4-year EFS with LDH > or = 500 IU/l compared with LDH < 500 IU/l was 49 +/- 3 versus 71 +/- 4% (P < 0.001). Furthermore, patients treated on the most recent protocol, which was short and more intensive, had a significantly improved survival compared with those on previous trials (4-year EFS 80 +/- 6 versus 54 +/- 2%, P < 0.001). In summary, the outcome for childhood Burkitt's and Burkitt-like lymphoma has recently improved with the use of short and intensive B-cell non-Hodgkin's lymphoma-directed therapy.

Adolescent↗
PubMed2003

House staff nonverbal communication skills and standardized patient satisfaction.

OBJECTIVE: To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills). DESIGN: Observational. SETTING: One university-based internal medicine residency program. PARTICIPANTS: Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year). RESULTS: Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station. CONCLUSION: Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

Female↗
PubMed2003

Interlaboratory variability in the quantification of new generation antiepileptic drugs based on external quality assessment data.

PURPOSE: To assess interlaboratory variability in the determination of serum levels of new antiepileptic drugs (AEDs). METHODS: Lyophilised serum samples containing clinically relevant concentrations of felbamate (FBM), gabapentin (GBP), lamotrigine (LTG), the monohydroxy derivative of oxcarbazepine (OCBZ; MHD), tiagabine (TGB), topiramate (TPM), and vigabatrin (VGB) were distributed monthly among 70 laboratories participating in the international Heathcontrol External Quality Assessment Scheme (EQAS). Assay results returned over a 15-month period were evaluated for precision and accuracy. RESULTS: The most frequently measured compound was LTG (65), followed by MHD (39), GBP (19), TPM (18), VGB (15), FBM (16), and TGB (8). High-performance liquid chromatography was the most commonly used assay technique for all drugs except for TPM, for which two thirds of laboratories used a commercial immunoassay. For all assay methods combined, precision was <11% for MHD, FBM, TPM, and LTG, close to 15% for GBP and VGB, and as high as 54% for TGB (p < 0.001). Mean accuracy values were <10% for all drugs other than TGB, for which measured values were on average 13.9% higher than spiked values, with a high variability around the mean (45%). No differences in precision and accuracy were found between methods, except for TPM, for which gas chromatography showed poorer accuracy compared with immunoassay and gas chromatography-mass spectrometry. CONCLUSIONS: With the notable exception of TGB, interlaboratory variability in the determination of new AEDs was comparable to that reported with older-generation agents. Poor assay performance is related more to individual operators than to the intrinsic characteristics of the method applied. Participation in an EQAS scheme is recommended to ensure adequate control of assay variability in therapeutic drug monitoring.

Anticonvulsants↗
PubMed2003

Domestic violence: increasing knowledge and improving skills with a four-hour workshop using standardized patients.

PURPOSE: Domestic violence (DV) is common, yet physicians feel unprepared to address it. Educational interventions may improve the care provided to DV victims, yet the effectiveness of interventions is often unproven. METHOD: Written questions and DV-specific standardized patient (SP) checklist items from an end-of-clerkship and fourth-year comprehensive multispecialty (the Clinical Performance Examination or CPX) examinations of medical students participating in a DV workshop using SPs was compared with nonparticipants. RESULTS: DV workshop participants' and nonparticipants' written question mean scores were 93.2% and 85.8%, respectively, p =.02. End-of-clerkship SP examination DV-specific checklist scores for participants and nonparticipants was 76.3% and 60.0%, respectively, p =.002. Workshop participants scored 44.1% on the CPX DV-specific checklist items versus 35.6% for the nonparticipants, p =.01. CONCLUSION: A DV workshop improved knowledge and skills assessed four and an average of 27 weeks later.

Clinical Clerkship↗
PubMed2003

Survey of reference ranges and clinical measurements for psychoactive drugs in serum.

Thirty-three members of the United Kingdom National External Quality Assessment Scheme for measurement of psychoactive drugs in serum responded to a questionnaire concerning 31 tricyclic, antipsychotic, and selective serotonin re-uptake inhibitor drugs. Considerable variation was found between laboratories in their reference ranges and in the observed range of measured drug concentrations in clinical samples. For the lower end of the reference range, the median ratio between the highest and lowest values reported was 6.8, while for the top end of the range, the median ratio was 3.6. Observed clinical values were significantly less than reference range values at the lower end of the range and significantly higher at upper-range values by median values of -57% and +47%, respectively. The median ratio between maximum and minimum measurements reported by laboratories was 10.0 for both the lowest non-zero measurements and the highest non-toxicological concentrations. The variation in clinical range values did not differ significantly from that in reference range values. The ratios take no account of local variation in patient groups and treatment regimens.

Antidepressive Agents, Tricyclic↗
PubMed2003

A shortened instrument for literacy screening.

The Rapid Estimate of Adult Literacy in Medicine (REALM-R), a new 8-item instrument designed to rapidly screen patients for potential health literacy problems, was administered to 157 patients. The REALM-R was correlated with Wide Range Achievement Test-Revised (WRAT-R) (.64) and demonstrated a Cronbach's alpha of 0.91. The REALM-R identified 26 of 30 persons scoring more than 1 standard deviation below the mean on the WRAT-R, corresponding to a sixth grade reading level. The REALM-R identified a substantial number of people who scored poorly on the WRAT-R, and depending on further studies of validity and reliability, may offer a practical approach to identify patients at risk for health literacy problems in a clinical setting.

Educational Status↗
PubMed2003

A model for setting performance standards for standardized patient examinations.

Setting standards for complex performance assessments is difficult. This report describes and evaluates a model for setting performance standards for standardized patient examinations. A variation of a modified Angoff standard-setting procedure was used to set cutoffs for a standardized patient exercise. Analysis of the procedure was based on evaluation of the impact of the iterative process, the ability of the final standards to accurately classify trainees and the judges' confidence in the procedure and final standards. The practicality of the process also was assessed. The iterative steps in this procedure led to a reduction in the variance between the judges' ratings. All seven judges reported confidence in the final standards. The mean time commitment for each judge was 4.7 work hours. This model for setting performance standards successfully set useful standards for this exam, was practical, and can be utilized to set performance standards for other standardized patient examinations.

Clinical Competence↗
PubMed2003

The loss of idealism throughout internship.

The purpose of this project was to understand how resident attitudes to specific types of patients change throughout their internship. Over a 3-year period all 1st-year internal medicine residents were asked to complete a 15-item survey regarding their attitudes toward certain patient types and the profession. The survey was administered the 1st day of the internship, again in mid-November, and in June in the last month of internship. Sixty-one of 80 interns (76% response) completed all three administrations of the survey. In general, there were statistically significant differences in attitudes from the first administration to the second in all categories (all changes reflecting less idealism), with attitudes remaining the same for the second to third administration. For example, interns believed significantly more patients requesting narcotics were drug seekers (19% vs. 33%/37%, p < .0001) and a lesser percentage of the elderly could care for themselves independently (62% vs. 50%/48%, p < .0001). We conclude interns become less idealistic toward patients and the profession throughout internship, with the greatest change within the first 5 months.

Affect↗
PubMed2002

Non-Hodgkin's lymphoma arising in bone in children and adolescents is associated with an excellent outcome: a Children's Cancer Group report.

PURPOSE: Non-Hodgkin's lymphoma (NHL) arising in bone is a heterogeneous histologic type of NHL that includes large-cell lymphoma, lymphoblastic lymphoma, and small noncleaved-cell lymphoma. NHL arising in bone is well recognized in adults but is less well characterized and infrequent in children and adolescents. PATIENTS AND METHODS: We performed a retrospective review of Children's Cancer Group (CCG) studies treating children and adolescents with NHL over a 20-year period (CCG-551, CCG-501, CCG-502, CCG-503, CCG-552, CCG-5911, and CCG-5941) and determined the response and event-free survival (EFS) rates in 31 patients with NHL arising in bone. RESULTS: The patients ranged in age from 3 to 17 years (median, 11 years; mean, 11 years), and 64.5% were male. All 31 (100%) patients achieved complete response. For 31 patients with NHL arising in bone, the product-limit estimated 5-year EFS was 83.8% +/- 6.7%. EFS in 17 patients with localized disease (Murphy stages I and II) was 94.1% +/- 5.7%, and EFS in 14 patients with disseminated disease (Murphy stage III) was 70.7% +/- 12.4% (log-rank P =.10). EFS in 17 patients treated with chemotherapy and radiation was 70.1% +/- 11.2%, and EFS in 14 patients treated with chemotherapy without radiation was 100% (P =.03). EFS in 26 patients with histology-directed treatment (LSA2-L2 or ADCOMP for lymphoblastic, other therapy for nonlymphoblastic) was 92.2% +/- 5.3%, and in five patients with nonhistology-directed treatment it was 40.0% +/- 21.9% (P <.001). CONCLUSION: NHL arising in bone is a heterogeneous type of NHL that makes up approximately 2.0% of NHL in children and adolescents on CCG studies. Response and survival in this young age group seem superb, with histology-directed treatment protocols without radiation in both localized and disseminated disease.

Adolescent↗
PubMed2002

Self-discontinuation of antiepileptic medication in pregnancy: detection by hair analysis.

PURPOSE: Concerns over teratogenicity of antiepileptic drugs (AEDs) during pregnancy must be balanced against the risks of seizures to the mother and developing fetus. Pharmacokinetic changes and vomiting may alter drug levels, but more important may be the patient's decision to stop medication before or during pregnancy. Compliance assessment traditionally relies either on self-reporting or on AED plasma level monitoring; neither provides reliable information on drug-taking behaviour over an extended interval (e.g., before, during, and after pregnancy). METHODS: We have used hair analysis to assess AED-taking behavior in pregnant women compared with nonpregnant female controls. Twenty-six pregnant women [mean age, 27.5 +/- 6.7 (SD) years] and 13 nonpregnant female epilepsy outpatients (mean age, 31.9 +/- 8.3 years) were studied. Carbamazepine (CBZ) or lamotrigine (LTG) concentrations were measured in 1-cm hair segments, and the within-subject variance in segmental hair concentrations of these drugs was calculated for each group. The variances of each group were then compared by using a variance ratio test. RESULTS: The variance of AED concentration in hair differed significantly between the pregnant and nonpregnant groups [variance ratio, 1.59 (p < 0.01)]. Four (15%) of the 26 pregnant patients had little or no AED in their proximal hair segments compared with more distal segments, apparently having discontinued their medication during pregnancy. Only one of these later disclosed having stopped her medication. One pregnant woman whose hair profile was similar to controls died suddenly at 30 weeks of gestation. CONCLUSIONS: This study confirms the perception that pregnant women with epilepsy frequently stop or greatly reduce their prescribed medication, usually without reference or acknowledgement to their clinician.

Adolescent↗
PubMed2002

Residents' ability to identify patients with poor literacy skills.

PURPOSE: To determine whether residents could identify patients with poor literacy skills based on clinical interactions during a continuity clinic visit. The authors hypothesized residents would overestimate patients' literacy abilities and fail to recognize many patients at risk for poor literacy. METHOD: The Rapid Estimate of Adult Literacy in Medicine-Revised (REALM-R) was administered to screen patients for potential literacy problems. Residents were asked "Do you feel this patient has a literacy problem?" and answered yes or no. Continuity adjusted chi-square was used to test for overestimation of literacy abilities by residents. RESULTS: REALM-R scores and residents' evaluations of literacy were available for 182 patients. The residents believed 10% of patients (18) had literacy problems based on their clinical interactions. Only three patients passing the literacy screen were incorrectly identified as at risk for literacy. Of the 90% of patients (164) the residents perceived to have no literacy problem, 36% (59) failed the literacy screen. CONCLUSION: Resident physicians overestimated the literacy abilities of their patients. A significant portion of these residents' patients may not have the skills to effectively interact with the health care system and are at increased risk for adverse outcomes.

Educational Status↗
PubMed2002

Scoring and performance of analysis and interpretation of toxicologic cases assessed by external quality assurance.

Quantitative analysis of toxicology cases requires knowledgeable interpretation. We describe a scoring scheme that integrates analytical and interpretive performance for such cases using a reward/penalty scoring scheme. This scheme has been validated on cases circulated over the previous 5 years to volunteer participants in the UKNEQAS for Drug Assays Scheme. We have been able to identify a subset of poorly performing laboratories that should desist from toxicologic analysis and interpretation.

Humans↗
PubMed2002

Review, deliberation, and voting: a study of selection decisions in a medical school admission committee.

BACKGROUND: Medical school admission committees differ in their decision-making procedures. Some assign ratings to groups of application materials to devise rank order acceptance lists, whereas others deliberate and vote on each separate application. PURPOSE: This study examined what the screening review and deliberative processes contribute to decision making in a medical school admission committee. METHODS: We reviewed records of admission committee members' preliminary votes on applicants after initial screening, final votes after committee deliberation, and written comments regarding issues of concern influencing their votes cast. Descriptive univariate and bivariate analyses are presented. RESULTS: Approximately one in five votes cast after initial screening was changed following committee deliberation, resulting in majority vote shifts in roughly 10% of cases containing votes by the same committee members at both time periods. Factors cited as influencing vote changes (in declining order of frequency) included Medical College Admission Test scores, medical experience, comparison with other applicants, grades, letters of evaluation, interviews, individual attributes, residency status, service experience, expressed desire of committee members to discuss the applicant at the meeting, American Medical College Application Service personal statement, and diversity. CONCLUSIONS: Admission committee members' voting behaviors appear to be influenced by the deliberative process. Future studies should explore the extent to which committee group dynamics influences decision making and the relative contribution of particular academic and nonacademic factors to vote-changing behavior.

College Admission Test↗
PubMed2002

Influence of methylenetetrahydrofolate reductase genotype, exercise and other risk factors on endothelial function in healthy individuals.

Cardiovascular disease has a multifactorial aetiology that is influenced by both genetic and environmental factors. Endothelial dysfunction is a key event in the pathogenesis of vascular disease that occurs before structural vascular changes or clinical symptoms are evident. Conventional risk factors, for example hypertension and diabetes mellitus, are associated with endothelial dysfunction, but the influence of other putative risk factors is not clear. The methylenetetrahydrofolate reductase (MTHFR) C677T genotype, a common polymorphism that induces hyperhomocysteinaemia, has been proposed as being a genetic risk factor for cardiovascular disease. A total of 126 healthy adults recruited by MTHFR C677T genotype (42 of each genotype, i.e. CC, CT and TT) underwent assessment of endothelial function. Brachial artery endothelium-dependent flow-mediated dilatation (FMD) was measured using high-resolution ultrasonic vessel "wall-tracking". Using multiple regression analysis, MTHFR genotype and 21 other subject and subject-lifestyle variables were investigated as potential predictors of endothelial function. FMD was influenced positively by frequency of aerobic exercise and by hormone replacement therapy, and negatively by increases in systolic blood pressure. MTHFR C677T genotype and the associated variation in plasma homocysteine levels did not influence FMD. Additionally, other factors, including plasma cholesterol and self-supplementation with either antioxidant vitamins or cod liver oil, showed no significant relationship with FMD, although these findings are compromised by the narrow range studied for cholesterol and the small number of subjects taking supplements. These observations have implications for risk factor management in the primary prevention of cardiovascular disease in healthy individuals.

Adolescent↗
PubMed2002

Stress and infertility.

This review highlights new directions for research on stress and infertility. The question of whether stress causes infertility is examined, using theoretical models derived from natural history and evolution, current models of the effects of chronic stress on the hypothalamic pituitary adrenal axis, and data relating the effects of stress on the reproductive cycle. Research on the stress of infertility treatment is reviewed, with the conclusion that there is a lack of solid evidence that infertility patients demonstrate more psychopathology than controls, and that there is modest evidence for an association between distress during treatment and the outcome of the treatment itself. The effects of infertility and infertility treatment on quality of life is discussed thematically, using previous literature and previously unpublished qualitative data from infertility patients. The effects of infertility on social, interpersonal, and identity aspects of quality of life are emphasized.

Adaptation, Psychological↗