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Biomedical subjects

D E Simpson

Publications and source records attributed to D E Simpson.

70 records · Page 4Linked to original sources
PubMed1987

"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↗
PubMed1987

New method for the chelation of indium-111 to monoclonal antibodies: biodistribution and imaging of athymic mice bearing human colon carcinoma xenografts.

B72.3, a murine monoclonal antibody (MAb) that reacts with 85% of human colon carcinomas as well as other epithelial neoplasias, was labeled with 111In using four chelating agents: 1-(p-isothiocyanatobenzyl)-DTPA (SCN-Bz-DTPA), isobutylcarboxycarbonic anhydride (MA-DTPA), cyclic anhydride (CA-DTPA), and 1-(p-isothiocyanatobenzyl)-ethylenediaminetetraacetic acid (SCN-Bz-EDTA). Comparative biodistribution and imaging studies were performed in athymic mice bearing human colon carcinoma xenografts (LS-174T). Tumor uptake of radiolabel was very similar between the chelates (30% ID/g) and tumors were identified in scintigraphic images with all the chelate-antibody complexes. The uptake by normal organs, especially the liver, was greater for MA-DTPA, CA-DTPA, and SCN-Bz-EDTA chelate-B72.3 IgG (1.3:1 to 2.5:1) in comparison to that found with the B72.3-SCN-Bz-DTPA (approximately 5:1) and abdominal organ, and uptake was very prominent on imaging with these chelate-MAb complexes but was virtually absent in the mice injected with B72.3-SCN-Bz-DTPA. Purification of the MAb-chelate complex by Sephadex G-50 chromatography followed by HPLC using a TSK-3000 column provided better subsequent biodistribution and also resulted in clearer images as compared to MAb chelate complexes purified by less rigorous purification protocols. We conclude that the 111In-SCN-Bz-DTPA complex is superior, at least when bound to MAb B72.3, to other chelate-complexes currently in use.

Animals↗
PubMed1987

Patients' and physicians' attitudes regarding the physician's professional appearance.

Although physician appearance has been a topic of interest to medical historians for more than two centuries, little objective investigation has been made into patients' and physicians' attitudes toward the physician's appearance. This study analyzed responses from 404 patients, residents, and staff physicians regarding their attitudes toward various aspects of the male and female physician's professional appearance. Positive responses from all participants were associated with traditional items of dress such as the dress, shirt and tie, dress shoes, and nylons, and for physician-identifying items such as a white coat and a name tag. Negative responses were associated with casual items such as blue jeans, scrub suits, athletic shoes, clogs, and sport socks. Negative ratings were also associated with overly feminine items such as prominent ruffles and female dangling earrings and such temporarily fashionable items as long hair on men, male earrings, and patterned hose on women. Overall, patients were less discriminating in their attitude toward physician appearance than physicians. Patients rated traditional items less positively and casual items less negatively. This study confirms the importance of the physician's appearance in physician-patient communication.

Adult↗
PubMed1987

Optic nerve pit.

Optic nerve pits are an uncommon congenital anomaly of the optic nerve head. Pits are generally recognized to represent an atypical form of optic nerve coloboma. The appearance of optic nerve pits can be quite variable and may simulate other anomalies of the optic nerve head, such as glaucoma or optic nerve tumor. Visual loss is present in a significant number of cases. Arcuate scotomas and a serous macular detachment have been associated with pits of the optic nerve. The mechanism for development of the serous maculopathy is not well understood.

Fundus Oculi↗
PubMed1986

Exudative age-related maculopathy.

While this patient was asymptomatic, patients need to be aware of visual changes which may be secondary to choroidal neovascular membranes. Amsler grid monitoring during the interval between examinations may assist in early detection. Detailed fundus examinations and patient education are also needed. While the efficacy of krypton treatment remains to be proven, timely diagnosis and appropriate referral, when a treatable lesion is present, will improve the prognosis for maintaining macular function in exudative ARM.

Age Factors↗
PubMed1986

Student and faculty assumptions about the nature of uncertainty in medicine and medical education.

Clinical reasoning involves an element of uncertainty. Teaching clinical reasoning involves understanding how students view uncertainty as well as how medical problems are solved. This study uses Perry's model of intellectual development to explore changes in how medical students, residents, and instructors think about the nature of knowledge. A total of 31 medical students, residents, and instructors completed the Widick and Knefelkamp Measure of Intellectual Development revised to focus specifically on uncertainty in medicine. Consistent with Perry's theory, scores reflected increasing degrees of acceptance of the role of uncertainty in medicine with increasing experience. Based on these results, it is concluded that to improve the effectiveness of teaching problem solving in medicine, faculty must challenge the assumptions held by medical students about the certainty of medical knowledge while teaching the process of clinical diagnosis.

Attitude↗
PubMed1984

Beta-substituted ethylamine derivatives as suicide inhibitors of lysyl oxidase.

Lysyl oxidase initiates the covalent cross-linking of elastin and collagen, converting lysyl residues in these proteins to peptidyl aldehyde residues. The present study explored structural and electron withdrawing features required to generate mechanism-based inhibitors of this enzyme with antifibrotic potential. It was found that the electron withdrawing nitrile moiety of beta-aminopropionitrile (BAPN), a naturally occurring syncatalytic inhibitor of lysyl oxidase, can be replaced by chlorine, bromine, or the nitro function to yield 2-haloamines or nitroethylamine compounds which also act as mechanism-based irreversible inhibitors of this enzyme. BAPN and 2-bromo- and 2-chloroethylamine exhibit similar KI values of 6-10 microM. However, the enzyme becomes irreversibly inactivated significantly faster by either of the 2-haloamines than by BAPN. 2-Nitroethylamine has by far the poorest affinity for the enzyme and inactivates much more slowly than the other amines of this series, consistent with interference with optimal enzyme-inhibitor interactions by the anionic nitro group. Unlike BAPN, 2-bromoethylamine is processed to a detectable aldehyde product upon incubation with enzyme, showing a partition ratio of 1.2 mol of acetaldehyde formed per mol of 2-bromo-ethylamine which becomes covalently incorporated in the enzyme. The results are consistent with the processing of 2-bromo-ethylamine to an enzyme-ethyleneamine Schiff base subject to hydrolysis to acetaldehyde or to covalent attack at carbon 2 by an enzyme nucleophile. Thus, beta-haloamines represent a new series of suicide inhibitors of lysyl oxidase which can inactivate the enzyme faster than BAPN and hence may have antifibrotic potential.

Amino Acid Oxidoreductases↗
PubMed1981

Substrate-directed modulation of elastin oxidation by lysyl oxidase.

The oxidation of an elastin substrate by highly purified bovine aortic lysyl oxidase (LO) is markedly influenced by amphiphilic molecules known to bind to elastin. Negatively charged elastin ligands, including fatty acids, bile salts or sodium dodecyl sulfate can completely inhibit the oxidation of lysine in elastin, the cationic amphiphilic ligands stimulate the enzymatic reaction five-fold, while small hydrophilic molecules of either charge or neutral detergents have no effect. In addition, evidence has been obtained that changes in the conformation of a synthetic polypeptide substrate markedly alter its susceptibility to LO. The coacervated state of the substrate is most readily oxidized and crosslinked by the enzyme. These results point to the importance of small ligands, electrostatic charge, and conformation as substrate-directed influences which can control the expression of LO activity.

Amino Acid Oxidoreductases↗
PubMedDate not supplied

Pharmaceutical representatives in academic medical centers: interaction with faculty and housestaff.

OBJECTIVE: To determine the nature, frequency and effects of internal medicine housestaff and faculty contacts with pharmaceutical representatives (PRs). DESIGN AND SETTING: The authors surveyed internal medicine faculty at seven midwest teaching hospitals and housestaff from two of the teaching programs. The survey asked about type and frequency of contacts with PRs and behavior that might be related to these contacts. T-tests and logistic regression were used to estimate the relationship between reported physician contacts and behavioral changes. PARTICIPANTS: Two hundred forty faculty (78%) and 131 house officers (75%) responded to the survey. RESULTS: Faculty and housestaff averaged 1.5 brief contacts per month with PRs. Housestaff averaged more than one meal/month at pharmaceutical company expense. Twenty-five percent of faculty and 32% of residents reported changing their practices at least once based on PR contact. Independent predictors of faculty change in practice were brief or extended conversations and free meals. Predictors of faculty requests for formulary addition were brief conversations and receipt of honoraria or research support. Only brief conversations independently predicted housestaff changes in practice. CONCLUSION: Academic housestaff and faculty have frequent PR contact; such contact is related to changes in behavior. The potential for influence of PRs in academic medical centers should be recognized, and their activities should be evaluated accordingly.

Academic Medical Centers↗
PubMedDate not supplied

A pleasure to work with--an analysis of written comments on student evaluations.

OBJECTIVE: Studies assessing rating scales on student evaluations are available. However, there are no data related to the written comments on these evaluations. This study was designed to evaluate these comments. METHODS: A content analysis was performed on the narrative section of pediatric clerks' evaluations. Final evaluations were obtained from 10 outpatient clinical sites staffed by full-time faculty over 14 months. A coding dictionary containing 12 categories (7 linked to clinical skills) was used. RESULTS: One thousand seventeen comments on 227 evaluations were coded. The mean number of comments per evaluation was 4. Learner and personal characteristics were the largest categories. Normative comments, such as "good physical exam," as opposed to more specific comments, such as "complete presentation," predominated in all categories. CONCLUSIONS: Evaluation comments were infrequently related to basic clinical skills and were not often specific enough to lead to effective change in a student's performance. Faculty development is needed to make final evaluation comments more useful for students.

Clinical Clerkship↗
PubMedDate not supplied

Physicians' attitudes about their professional appearance.

Thirty-five residents and 77 staff physicians from three residency programs in Minnesota and Wisconsin completed questionnaires about their attitudes toward various components of the physician's appearance. Most participants showed positive responses to traditional physician attire such as white coat, name tag, shirt and tie, dress pants, skirt or dress, nylons, and dress shoes. Negative responses were associated with casual items such as sandals, clogs, athletic shoes, scrub suits, and blue jeans. Cronbach's alpha analysis identified four cohesive appearance scales: traditional male appearance, casual male appearance, traditional female appearance, and casual female appearance. Older physician participants favored a more traditional appearance than did younger physicians, and of the physicians who were 35 years and younger, staff physicians tended to show more conservative views toward professional appearance than did residents.

Adult↗
PubMedDate not supplied

Family physicians' and internists' consideration of psychosocial hypotheses during the diagnostic process.

This study compared the psychosocial hypotheses generated by 12 internists and 12 family physicians as they reviewed three patient presentations with diagnoses of congestive heart failure, common duct stone, and sick sinus syndrome. Family physicians, compared to internists, produced a significantly higher proportion of psychosocial hypotheses on two of the three cases. Diagnoses considered more frequently by family physicians included anxiety, anxiety-depression, psychogenic pain, alcoholism, and other alcohol-related diseases. These results are consistent with the findings of previous studies reporting that family physicians attend to psychosocial problems to a greater degree than do internists.

Affective Symptoms↗
PubMedDate not supplied

Redesigning a psychological counseling course: issues and guidelines.

Though the adequacy and relevancy of behavioral science education for family practice residents has been questioned, the existing literature offers only limited assistance for undertaking curriculum redesign. More specifically, there is no advice on how differences in teacher and learner perceptions of behavioral science can be used to develop goals, content, and teaching strategies in this area. This paper describes how a behavioral science course in psychological counseling was systematically redesigned, guided by six specific questions: (1) What are the instructor's assumptions about the subject matter? (2) How does the learner perceive course material? (3) What outcomes should be obtained? (4) What content matches desired outcomes? (5) What are the most suitable teaching strategies? (6) How can effectiveness of instruction be evaluated? Each question is outlined, and its application to the current course is discussed. Residents' self-assessments indicate knowledge gain in ability to articulate a counseling framework, to gather psychological information, and to intervene appropriately as a result of the course. The data reflect the need to expose residents to theoretical concepts as well as practical content when teaching counseling.

Counseling↗