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Biomedical subjects

D E Simpson

Publications and source records attributed to D E Simpson.

At least 19 recordsLinked to original sources

Women physicians in dual-physician relationships compared with those in other dual-career relationships.

This study compared the career and domestic responsibilities of women physicians whose domestic partners were physicians (WP-Ps) with those of women physicians whose domestic partners were not physicians (WP-NPs). In 1988 the authors surveyed 602 women physicians in a large midwestern city regarding their career and domestic roles; 390 were physicians in training (students and residents), and 212 were physicians in practice (academic medicine and private practice). Overall, 382 (63%) responded; of the 382, 247 (65%) had domestic partners; of these 247, 91 (37%) were WP-Ps and 156 (63%) were WP-NPs. The WP-Ps were found to be twice as likely as the WP-NPs to interrupt their careers to accommodate their partners' careers. The WP-Ps also assumed significantly more domestic responsibilities and worked fewer hours practicing medicine than did the WP-NPs. The 163 women physicians in training (44-48%-of the WP-Ps and 119-76%-of the WP-NPs) demonstrated a more egalitarian division of labor overall, with no significant differences between the WP-Ps and the WP-NPs. The authors recommend that longitudinal studies be undertaken to determine whether women physicians in training continue this trend as they enter the practice of medicine.

Adult

Comparing the transfusion medicine content of the NBME's examinations in 1984-1985 and 1989-1990.

Recognition of the seriousness of transfusion-transmitted diseases has been demonstrated by U.S. medical schools through the integration of transfusion medicine (TM) content into their curricula. To evaluate the degree to which these changes in curricula have been reflected in the National Board of Medical Examiners' (NBME) examinations, a study conducted in 1991 evaluated the proportions of TM-related items on Parts I and II of the NBME examinations for 1984-1985 versus 1989-1990. Both Part I (basic sciences) and Part II (clinical sciences) demonstrated significant gains in TM items between the comparison periods (p less than .001), with Part II having the higher gain. An analysis of students' knowledge revealed that students in 1989-1990 tended to perform better on TM items than on examination items generally. The increases in TM content and student performance on TM items on the 1989-1990 examinations suggest that the national effort to expand and improve teaching of TM in U.S. medical schools has been effective.

Blood Transfusion

Penetrating injury from hammering with subtle ocular damage.

Penetrating ocular injuries are usually associated with major disruption of the globe and vision loss. On occasion, the signs and symptoms accompanying an intraocular foreign body can be subtle. Such a case is presented in this paper and hammer injuries as a cause of penetrating ocular injury are reviewed.

Accidents, Occupational

Attitudes of internal medicine faculty and residents toward professional interaction with pharmaceutical sales representatives.

We surveyed faculty and residents from seven hospitals affiliated with three academic internal medicine training programs about their perceptions of the informational and service benefits vs the risks of ethical compromise involved in interactions with pharmaceutical sales representatives. Questionnaires were returned by 467 (81%) of 575 physicians surveyed. Residents and faculty generally had somewhat negative attitudes toward the educational and informational value of detailing activities at their institutions but indicated that representatives supported important conferences and speakers. Residents were more likely than faculty to perceive contacts with sales representatives as potentially influencing physician decision making. Sixty-seven percent of faculty and 77% of residents indicated that physicians could be compromised by accepting gifts. More than half of the physicians who suggested that such compromise was possible indicated that acceptance of gifts worth more than +100 from drug companies would be likely to compromise a physician's independence and objectivity. A majority of both faculty and house staff favored eliminating presentations by pharmaceutical representatives at their hospitals. Only 10% thought they had had sufficient training during medical school and residency regarding professional interaction with sales representatives.

Adult

Medical and nursing students' attitudes about AIDS issues.

A 12-item questionnaire was administered in late 1987-early 1988 to 445 medical students, 133 medical school applicants, and 111 nursing students to assess any differences in their attitudes toward medicine-related AIDS issues. These groups were also given a 31-item test of their knowledge of AIDS issues. Significant differences by levels of knowledge were obtained for eight of the 12 attitude items. For example, the more knowledgeable the student, the less likely he or she was to refuse treatment to an AIDS patient, to require mandatory AIDS testing of physicians, or to require medical personnel to wear gloves. The findings strongly suggest that education has an important role in changing attitudes about AIDS in a direction that fosters better health care for AIDS patients.

Acquired Immunodeficiency Syndrome

Clinical features of occipital infarction.

Occipital infarction may only cause visual symptoms. A homonymous visual field defect of various configurations is the most common clinical finding. Additionally, central vision, color vision and visual associative function also may be impaired. In this paper three cases of occipital infarction are presented and the clinical features of this condition discussed.

Aged

Teaching and funding nutrition instruction in family practice education.

Nutrition instruction is accepted as an important element of physician education, but is often not a formal part of medical school or residency training. Personnel and funding are often cited as the major factors that limit nutrition instruction. Because family medicine residency programs have been in the forefront of nutrition instruction, a nationwide survey of these programs was conducted to examine the nature, staffing, and funding mechanisms for nutrition education. Results of the 1986 survey reported in this study indicate that registered dietitians were available to 89% of the programs in the United States and are supported by a combination of funding sources. The implications of these findings are discussed.

Dietetics

Medical students' perceptions of cheating.

In 1985, 683 students at a large private upper-midwestern medical school were surveyed concerning the appropriateness of traditional cheating behaviors and behaviors related to professional misconduct and dishonesty in patient care. They also rated the acceptability of various rationalizations for these behaviors. The students agreed that traditional forms of academic cheating are inappropriate, but they did not agree about the appropriateness of certain behaviors in the areas of patient care and professional misconduct.

Crime

Retinal macroaneurysms: the natural history in four patients.

Macroaneurysms of the retinal arterioles are a clinical entity distinct from the aneurysmal dilations associated with Coats' disease, Leber's disease, Eales' disease, and angiomatosis retinae. The pathogenesis is not completely understood, but they are closely associated with systemic hypertension, generalized atherosclerosis, and age. Macroaneurysms have been classified into three major groups: exudative, hemorrhagic, and quiescent. Four examples of macroaneurysms are presented with photographic documentation. The clinical appearance, natural history, complications, and management of this retinal entity are discussed.

Aged

A survey of sued and nonsued physicians and suing patients.

To systematically assess the impact of malpractice litigation on the doctor-patient relationship and to collect data that might suggest effective tort reform, we surveyed 642 sued physicians, nonsued physicians, and suing patients in Wisconsin. Parallel forms of survey instruments obtained information regarding changes in physicians' practices, changes in attitudes toward patients or physicians, and changes in physical and emotional well-being as a result of malpractice litigation or the threat of the same. In addition, opinions regarding causes and deterrents of malpractice litigation were obtained. Results suggested that claims or threats of malpractice suits had a negative impact on physicians' practices and emotional well-being; that this negative impact was more pronounced when the sued physician had been more personally involved with his patient prior to the malpractice claim; and that suing patients' and sued physicians' understanding of their relationship before the malpractice claim significantly differed. All respondents viewed improved physician-patient communication as the most effective method of preventing malpractice claims. Informal, alternative dispute resolution mechanisms in hospitals and clinics and improved peer review may decrease litigation and its deleterious effects.

Adult

Knowledge of AIDS among health care students.

To assess the level of understanding about AIDS among future health care professionals, we developed and administered a 31-item test covering five AIDS-related knowledge domains to selected undergraduate students, medical school applicants, medical students and pre-clinical nursing students. The percentage of correct answers ranged from 74% for questions about mechanisms of transmission to 59% for items related to testing and interpretation. Seventy-two percent of questions on clinical illness and disease were answered correctly. The number of questions answered correctly was a function of educational level. The students were generally knowledgeable about the risk factors related to sexual transmission, interpretation of the AIDS antibody test, and symptoms of AIDS. They were less informed about issues related to occupational acquisition of human immunodeficiency virus (HIV) and clinical details. Medical educators need to develop educational programs providing accurate and up-to-date knowledge about this disease.

Acquired Immunodeficiency Syndrome

Compressive optic neuropathy secondary to chronic sinusitis.

The paranasal sinuses surround the orbit on three sides. The thin bony walls of the sinuses are an ineffective barrier to the spread of infection to either the orbit or the intracranial cavity. In this report a case of compressive optic neuropathy secondary to chronic sinusitis is presented. The anatomical and physiologic relation between the sinuses and the orbit are reviewed and sinusitis is discussed.

Aged

Treatment of sprained ankles by physiotherapists at professional soccer clubs.

Fifty-three physiotherapists working at professional soccer clubs responded to a postal questionnaire on the treatment of sprained ankles. Elevation, the application of ice and compression bandaging were commonly recommended for the first 24-48 hours followed by early mobilisation. A variety of other physiotherapy techniques were used and non steroidal anti-inflammatory drugs commonly dispensed. The application of these techniques to routine casualty practice is considered.

Adult

Radioimmunoscintigraphy of colon cancer with iodine-131-labeled B72.3 monoclonal antibody.

The monoclonal antibody B72.3 is a murine IgG1 that is reactive with a wide range of carcinomas while demonstrating little or no reactivity to normal adult tissues. We have shown (27) quantitative analyses demonstrating selective targeting of [131I]B72.3 IgG to metastatic colorectal cancer. We have also shown (28) that (a) B72.3 localization in metastases correlated with the percentage of tumor cells in the biopsy specimen; (b) B72.3 could localize in carcinomas of various degrees of differentiation with best localization in well-differentiated tumors and (c) [131I]B72.3 could penetrate tumor masses, as determined by autoradiographic studies. We report here the various parameters effecting radioimmunoscintigraphy with [131I]B72.3 IgG. Sixteen of 35 patients with colorectal carcinoma had positive scans (without blood-pool subtraction). High circulating TAG-72 antigen levels correlated with positive scans. No dose dependent differences were seen in biodistribution or tumor imaging. The plasma clearance and urinary excretion of [131I]B72.3 and [125I]BL-3 (nonspecific control) were not significantly different. No toxicity was noted. Approximately one-half of patients developed human anti-mouse immune response.

Adolescent

Moonlighting.

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Aged

The diagnostic process in primary care: a comparison of general internists and family physicians.

This investigation examined the formulation of diagnostic hypotheses by general internists and family physicians in response to three patient cases (dyspnea, abdominal pain and syncope). The investigation was conducted in the United States. Physician responses to sequentially presented written clinical information were audiotaped. Each transcribed protocol was scored to enumerate and characterize the hypotheses considered by physicians in each specialty. Results of the analyses of variance of hypothesis measures revealed that internists generated more hypotheses than family physicians and that the internist's hypotheses were more specific and were less likely to be generated by other physicians. In addition, internists tended to consider hypotheses more closely related to the final diagnosis sooner in the case presentation than did family physicians. The findings of increased number, specificity, and uniqueness of hypothesis considered by internists are consistent with previously demonstrated differences in the amount and nature of diagnostic information collected by family physicians and internists.

Diagnosis, Differential

"Entering the adult world": developmental issues in medical education.

Members of a medical school graduating class of 1985 were studied as freshmen and prior to graduation to assess the developmental issues of autonomy, intimacy and career choice. Results indicated that senior medical students were more likely to address and resolve these issues than were freshmen, that students who had resolved these issues were better able to cope with the stressors of medical education, and that senior men and women responded to these issues differently. Women were significantly more concerned about career choice, competency, intellectual challenge, socializing with peers and developing an intimate relationship. Individuals who were in committed relationships were better able to cope with the stressors of medical school than their noncommitted colleagues, as evidenced by their reporting fewer depressive episodes and lower use of alcohol and drugs.

Adaptation, Psychological