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Biomedical subjects

T Simpson

Publications and source records attributed to T Simpson.

At least 19 recordsLinked to original sources
PubMed1992

Surgical treatment of ductal carcinoma in situ of the breast. 10- to 20-year follow-up.

Between 1967 and 1977, 36 patients received treatment at the Virginia Mason Medical Center in Seattle, Wash, for ductal carcinoma in situ of the breast. Twenty-five patients had modified radical mastectomies, 10 had radical mastectomies, and one had a simple mastectomy. Twenty-seven patients have been followed up for at least 10 years and are without known recurrence (mean follow-up, 17.7 years; range, 8 to 24 years), eight patients died without known recurrence (mean follow-up, 10.6 years; range, 6 to 14 years), and one patient with a prior contralateral mastectomy for infiltrating cancer of the breast had a recurrence in the scalene nodes on the side of the infiltrating cancer and died of metastatic cancer. No patients with ductal carcinoma in situ had local recurrences in the ipsilateral breast or chest wall, and no patients developed cancers in the contralateral breast; one patient had axillary metastasis. Twenty-eight (78%) of 36 patients had multicentric ductal carcinoma in situ in their mastectomy specimens. Twenty-three (88%) of 26 patients with comedocarcinoma-type ductal carcinoma in situ had multicentric lesions. Conversely, patients with low-grade nuclear papillary ductal carcinoma in situ did not have multicentric lesions. Five (14%) of 36 patients had incidental microinvasion discovered in the mastectomy specimens; all had comedocarcinoma. In summary, our study of patients with ductal carcinoma in situ revealed that (1) mastectomy provided excellent local and systemic control; (2) cancer in the contralateral breast was infrequent; (3) axillary metastasis was rare; and (4) histologic features of tumors markedly affected the frequency of multicentricity and chance for microinvasion.

Breast Neoplasms↗
PubMed1992

Monocular acuity in the presence and absence of fusion.

Because little is known about monocular acuity during binocular fusion, acuity of the right eye was measured in binocularly normal subjects, with the fellow eye open or fully occluded. The target was flashed for 65 ms or presented sinusoidally for 1 s. Subjects had both eyes optimally focused, or the right eye defocused by +3.00 D. Monocular acuities were equivalent during fusion or occlusion when both eyes were optimally focused. Acuity of the defocused eye was reduced when the fellow eye was open compared to when it was occluded. Suppression of the blur, therefore, produced a measurable reduction in recognition thresholds. As monocular acuity was not measurably affected by the fellow eye when each eye was in focus, the finding that monocular vision is improved with the fellow eye occluded should be ascribed to something other than suppression or more sensitive spatial measures of the suppression should be obtained.

Humans↗
PubMed1992

The effects of epidural versus parenteral opioid analgesia on postoperative pain and pulmonary function in adults who have undergone thoracic and abdominal surgery: a critique of research.

Studies comparing epidural and parenteral opioid analgesia for patients experiencing thoracic or abdominal surgery are analyzed with respect to differences in postoperative pain and pulmonary function. Although most studies suggest that epidural analgesia is superior for postoperative pain relief, few clearly demonstrate an improvement in pulmonary function attributable to epidural analgesia. Recommendations for future research are proposed to improve the design, measurement, analysis, and reporting of studies. Research relevant to the nursing care of patients receiving epidural analgesia is suggested.

Abdomen↗
PubMed1991

The family as a source of support for the critically ill adult.

A conceptual framework of supportive family functions derived from a previous analysis of taped visits to coronary care unit (CCU) patients was used to analyze CCU and surgical intensive care unit (SICU) patients' recollections about visits. The framework of family functions was supported by the patients' recollections. However, CCU patients recall behaviors in a different order of frequency than previously described with visit transcript analysis. Both CCU and SICU patients frequently recall caring actions of the family and evaluated visits overall as helpful. Principles are proposed for nurses in assisting families and patients to cope with the critical illness episode and thus provide a supportive visiting environment for patients.

Adaptation, Psychological↗
PubMed1991

A comparison of hypertensive and nonhypertensive coronary care patients' cardiovascular responses to visitors.

Patients with and without hypertension in a coronary care unit (n = 24) were compared with respect to cardiovascular responses to both a family visit and an interview by an investigator. Variables for each of the four cardiovascular indicators (systolic blood pressure, diastolic blood pressure, heart rate, and premature ventricular contractions) included the value before, the highest value during, the lowest value during, and the value after each social interaction condition. The highest group means for systolic blood pressure and heart rate were significantly higher for patients with hypertension than for patients without hypertension under both the interview and visit conditions. Differences in cardiovascular responses were not significantly greater for family visits than for interviews for patients with hypertension compared with those without hypertension. Thus, although hypertensive patients had greater cardiovascular reactivity to both social interaction conditions than nonhypertensive patients in the coronary care unit, family visits were no more physiologically stressful than a comparative interaction condition.

Adult↗
PubMed1991

The suppression effect of simulated anisometropia.

Although there is evidence that differential interocular image clarity degrades binocular performance (for example, reducing stereo sensitivity) little is known about how this sensitivity reduction occurs. As there is evidence that suppression scotomas are induced in the more defocused eye, the presence and approximate size of suppression scotomas induced with uni-ocular defocus was investigated in five binocularly normal subjects. The targets comprised a fusional lock and a suppression check for each eye and the task of each subject was to report the presence of the suppression check with varying amount of defocus. There was a range of simulated anisometropia over which suppression did not occur (approximately +/- 0.50 DS). Thereafter the probability of suppressing a small foveal target increased approximately linearly until the target was always suppressed. Greater amounts of simulated anisometropia produced larger suppression scotomas. However, less anisometropia was required to produce an equivalent sized suppression scotoma if greater amounts of fusional detail were provided. These results suggest that the decrement in binocular performance which accompanies simulated anisometropia may occur because of localized inhibition in the more defocused eye and is not solely due to loss of resolution in that eye.

Anisometropia↗
PubMed1991

Critical care patients' perceptions of visits.

Although visiting has been studied from nurses' and families' perspectives, patients' preferences for visits and their evaluations of visits have not been explored. In addition, coronary care unit (CCU) and surgical intensive care unit (SICU) patients' visit preferences have not been compared. Relationships among patients' preferences for visits, select personal and illness characteristics, and the perceived impact of visits were compared in a sample of 50 CCU and 50 SICU patients. Patients' preferences for the length of visits differed according to their age, particularly for CCU patients. Patients' preferences for the frequency of visits were similar to their usual preferences for being with others. Perceived illness severity, especially for SICU patients, was positively related to the preferred number of visitors. A greater proportion of SICU patients preferred visits any time, day or night, compared with CCU patients. Patients predominantly evaluated visits as helpful and not tiring. Results suggest the need to tailor visits to patients' preferences by considering personal and illness-related characteristics.

Age Factors↗
PubMed1991

The cost of nursing excellence in critical care.

The results of the American Association of Critical-Care Nurses Demonstration Project support the contention that high quality critical care nursing can be provided to patients at a reasonable cost. In addition, the data refute the notion that elements influenced by nurses--supplies and nursing care--are the most costly portion of the total hospital charge.

Costs and Cost Analysis↗
PubMed1990

Beyond scripts: a note on the capacity of right hemisphere-damaged patients to process social and emotional content.

Individuals with right hemisphere damage (RHD) can comprehend simple scripts but have difficulties understanding more complex forms of discourse such as stories and jokes. This study sought to discover the point beyond simple scripts at which such patients begin to experience difficulties. Three-sentence, script-like vignettes which described everyday situations were created along two major dimensions: a social dimension (reflecting presence or absence of interactions between characters); and an emotional dimension (reflecting a positive, negative, or neutral emotion felt by a protagonist in the situation). Right hemisphere-damaged patients were asked to provide emotional characterizations of, and continuations to, these situational vignettes. Results indicated that individuals with right hemisphere damage were more likely than control subjects to attribute a positive emotional state to a character in a neutral situation. In other respects, there were no significant differences between RHD subjects and controls, although the RHD subjects made significantly more factual errors in their continuations than did control subjects.

Adult↗
PubMed1990

Skeletal muscle oxidative capacity, antioxidant enzymes, and exercise training.

The purposes of this study were to determine whether exercise training induces increases in skeletal muscle antioxidant enzymes and to further characterize the relationship between oxidative capacity and antioxidant enzyme levels in skeletal muscle. Male Sprague-Dawley rats were exercise trained (ET) on a treadmill 2 h/day at 32 m/min (8% incline) 5 days/wk or were cage confined (sedentary control, S) for 12 wk. In both S and ET rats, catalase (CAT), superoxide dismutase (SOD), and glutathione peroxidase (GPX) activities were directly correlated with the percentages of oxidative fibers in the six skeletal muscle samples studied. Muscles of ET rats had increased oxidative capacity and increased GPX activity compared with the same muscles of S rats. However, SOD activities were not different between ET and S rats, but CAT activities were lower in skeletal muscles of ET rats than in S rats. Exposure to 60 min of ischemia and 60 min of reperfusion (I/R) resulted in decreased GPX and increased CAT activities but had little or no effect on SOD activities in muscles from both S and ET rats. The I/R-induced increase in CAT activity was greater in muscles of ET than in muscles of S rats. Xanthine oxidase (XO), xanthine dehydrogenase (XD), and XO + XD activities after I/R were not related to muscle oxidative capacity and were similar in muscles of ET and S rats. It is concluded that although antioxidant enzyme activities are related to skeletal muscle oxidative capacity, the effects of exercise training on antioxidant enzymes in skeletal muscle cannot be predicted by measured changes in oxidative capacity.

Animals↗
PubMed1990

Cardiovascular responses to family visits in coronary care unit patients.

Changes in four cardiovascular indicators: systolic blood pressure, diastolic blood pressure, heart rate, and premature ventricular contractions, were studied as responses to family visits and a 10-minute interview with the investigator in 24 patients in a coronary care unit. By use of a repeated-measures design, data were compared by multivariate analysis of variance. No significant differences were found between the group mean systolic and diastolic blood pressure, heart rate, and rate of premature ventricular contractions during family visits and interviews. The lowest systolic and diastolic blood pressure values were significantly lower during the visit than during the interview, suggesting that the visit had a calming effect on patients. Although the highest heart rate was significantly higher during the visit than during the interview, the difference was clinically inconsequential. The wide variance in premature ventricular contraction values suggests individual variation in responses, but no significant differences were found between visits and interviews. Although family visits were no more physiologically stressful than a comparative social interaction, select subsamples of patients with cardiac disease should be studied for more specific reaction patterns.

Adult↗
PubMed1989

Traumatogenicity: effects of self-reported noncombat trauma on MMPIs of male Vietnam combat and noncombat veterans treated for substance abuse.

A recent review of the literature on Post-Traumatic Stress Disorder (PTSD) and the MMPI has shown that all previously published studies have been limited to clinical groups whose trauma occurred in Vietnam combat. The purpose of this study was to test hypotheses that predict higher MMPI and PTSD scale scores among combat veterans who differ in degrees of noncombat traumas. Results support predictions. Those who reported more noncombat traumas attain significantly higher MMPI scores for scales F, Hypochondriasis, Hysteria, Psychopathic Deviate, Psychasthenia, Schizophrenia, Mania, Social Introversion, and an MMPI PTSD score (Keane, Malloy, & Fairbank, 1984). Moreover, noncombat effects are manifested differentially: Combat veterans with higher noncombat trauma evidence greater social withdrawal, whereas noncombat veterans who report higher noncombat trauma are characterized by higher anxiety. MMPI elevations were progressively higher as groups increased in degrees of combat and noncombat trauma: noncombat and low combat trauma veterans were the better adjusted, and combat veterans with higher noncombat trauma were the worst adjusted. Results provide descriptive validity for PTSD as a construct and underscore the importance of assessing frequency and intensity, as well as types of traumas and stresses, in the background histories of substance abusers and other clinical groups as well.

Adult↗
PubMed1985

Tenckhoff catheter placement: surgical aspects.

A 3-year retrospective review of 110 consecutive Tenckhoff catheter placements was undertaken. Major complications were found in 3.6 per cent of cases and minor complications occurred in 30 per cent. Analysis of cases in which catheters failed revealed that obesity and prior abdominal surgery occurred in 75 per cent of these patients. Attention to these factors and the use of appropriate techniques of placement and, in special situations, the use of endoscopy and fluoroscopy have reduced the failure rate of these high-risk situations. Management of infective complications are outlined and should include continued antibiotic dialysis and catheter replacement only if persistent peritonitis or fungal peritonitis occur. With these guidelines, improved peritoneal dialysis can be undertaken with less morbidity to the patient.

Catheters, Indwelling↗
PubMed1982

Chicken ovalbumin gene fused to a herpes simplex virus alpha promoter and linked to a thymidine kinase gene is regulated like a viral gene.

We are describing a system for the introduction, selection, and expression of eucaryotic genes in higher eucaryotic cells. The carrier consisted of the herpes simplex virus 1 (HSV-1) tk gene covalently linked to an HSV-1 alpha promoter directed away from the tk gene. In this study we fused to the alpha promoter the 5' transcribed noncoding sequences and the coding sequences of the chicken oviduct ovalbumin gene. Cells converted to the TK+ phenotype with this chimeric fragment produced an ovalbumin precursor which was processed and secreted into the extracellular fluid. The ovalbumin gene utilized the HSV-1 alpha promoter and was regulated as a viral gene inasmuch as inversion of the genomic DNA relative to the alpha promoter resulted in no ovalbumin synthesis, and production of ovalbumin was enhanced after superinfection with HSV-1. Synthesis of ovalbumin was not detected when cDNA was linked to the HSV-1 alpha promoter. The carrier system described in this study is suitable for introduction, selection, and expression of eucaryotic genes whose natural promoter is either weak or requires the presence of regulatory elements which may be absent from undifferentiated cells in culture.

Animals↗