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D S Smith

Publications and source records attributed to D S Smith.

At least 37 records · Page 2Linked to original sources
PubMed2000

Music therapy assessment in school settings: a preliminary investigation.

The present investigation was undertaken in response to music therapists working in school settings for information relating to the availability of music therapy assessments and the feasibility of standardizing an assessment instrument for music therapists to use in school settings. Five research questions were identified, and the music therapy literature was surveyed to compile responses to those questions. Three different online data bases (ERIC, PsycINFO, and Article 1st) were used, covering articles published between 1980 and 1997. Individual hand searches were done of the Arts in Psychotherapy, Journal of Music Therapy, Journal of Research in Music Education, Journal of the International Association of Music for the Handicapped, Music Therapy and Music Therapy Perspectives. The questions and responses were as follows: 1. Which music-based assessment tools are being used with children with disabilities? Little commonality in assessment tools being used by music therapists and researchers was discovered. Of the total 41 studies, 20 (49%) reported using a "named" or "titled" assessment tool, and in the remaining 51% of studies, the authors reported using an untitled, and usually experimenter-designed, original assessment tool. 2. Have certain assessments been used in more than one study? Very limited replication of existing assessments was found. Of the 16 "named" assessments, only 3 were found to be used in more than one research study. 3. Are the actual assessments published along with the articles describing their use? Only 3 of the 20 studies using named assessments were published along with the journal article. Of the remaining 21 studies using original, experimenter-designed assessment tools, only 6 (28%) had the assessment instrument published with the article. 4. What is the primary purpose for using the assessment? Six primary purposes emerged from the review of the literature: to compare with data obtained from other assessment measures or from other populations (39%), as a baseline or pretest measure (29%), to determine eligibility for services or the receipt of treatment (12%), to determine the psychometric properties of the assessment (7%), suitability of the instrument for the given population (7%), and the identification of musical preferences (5%). 5. What are the musical or nonmusic elements being assessed? Musical elements were: music perception (37%), musical aptitude (29%), musical preferences (12%), and attention to/enjoyment of music (2%). Nonmusical behaviors/responses were: self-expression (10%), motor responses (10%), behavioral responses (7%), cognitive development (2%), and acts of communication (2%). 6. What subject populations are being assessed? Subject populations were: children with developmental disabilities/mental retardation (44%), children with autism (10%), children with hearing impairments (17%), "psychiatric" clients or emotionally disturbed (22%), individuals described as "handicapped" (5%), individuals with physical disabilities (2%), and a student with a speech impairment (2%). Nondisabled individuals were also included in 12 of the aforementioned studies.

Child↗
PubMed2000

Blunt splenic injuries: dedicated trauma surgeons can achieve a high rate of nonoperative success in patients of all ages.

BACKGROUND: Selective nonoperative management (NOM) of blunt splenic injuries is becoming a more prevalent practice. Inclusion criteria for NOM, which have been a source of controversy, continue to evolve. Age > or = 55 years has been proposed as a predictor for failure of and even a contraindication to NOM of blunt splenic trauma. Additionally, the high rate of NOM in children (up to 79%) has been attributed to their management by pediatric surgeons. We evaluated our experience with NOM of blunt splenic injury with special attention to these age groups. METHODS: By using our trauma registry, all patients with blunt splenic injuries (documented by computed tomography, operative findings, or both) cared for over a 36-month period, at a single American College of Surgeons verified Level I trauma center were reviewed. Detailed chart reviews were performed to examine admission demographics, laboratory data, radiologic findings, outcome measures, and patient management strategy. All patients were managed by nonpediatric trauma surgeons. We then compared our adult data with that in the recent literature and our pediatric data with that of the National Pediatric Trauma Registry over the same time period. RESULTS: We identified 251 consecutive patients with blunt splenic injuries. Eighteen patients who expired in the immediate postinjury period were excluded from statistical evaluation. No deaths occurred as a result of splenic injury. Of the remaining 233 patients, 73 patients (31%) required early celiotomy, 160 patients (69%) were selected for NOM, with 151 patients (94%) being successfully managed without operation. Blunt splenic injury occurred in 23 patients age 55 years or older. Eighteen patients (78%) were selected for NOM and 17 patients (94%) were successfully treated without operation. Blunt splenic injury occurred in 35 patients less than 16 years of age. Thirty-two patients (91%) were selected for NOM. Thirty-one patients (89% of all pediatric patients) were successfully treated without operation. CONCLUSION: Age > or = 55 years is not a contraindication to nonoperative management of blunt splenic injuries. Children with blunt splenic injuries can be successfully managed nonoperatively by nonpediatric trauma surgeons.

Adolescent↗
PubMed2000

Concordance of clinical findings and clinical judgment in the diagnosis of streptococcal pharyngitis.

OBJECTIVE: It is uncertain how reliably clinicians apply clinical predictors of group A beta hemolytic streptococcal pharyngitis (GABHSP) to form a clinical impression, and how reliably this impression predicts culture results. The objective was to study clinician accuracy in diagnosing GABHSP. METHODS: This was a prospective cohort study, conducted at an urgent care center of a major university. A convenience sample of 218 patients, aged 9-83 years, presenting with sore throat, was enrolled. Symptoms and signs of pharyngitis were documented on a standardized form; the likelihood of GABHSP was plotted on a visual analog scale; and throat culture was obtained. A comparison was then made between the clinical impression on presentation and the throat culture result. RESULTS: Throat cultures were positive for GABHSP in 41 patients (19%). The probability of GABHSP was related to node size and tenderness, tonsillar exudate and hypertrophy, and pharyngeal erythema (p<0.05); but not throat soreness, degree of fever, or cough. A strong clinical impression of GABHSP (>50% on the visual analog scale) was associated with tonsillar exudate and hypertrophy, tender nodes, and pharyngeal erythema. Together, these four predictors had a sensitivity of 71%, a specificity of 77%, and a positive predictive value of 46%. CONCLUSIONS: Clinicians in this study based their impression of GABHSP on the most reliable symptoms and signs. While a strong clinical suspicion of GABHSP predicted a greater probability of positive culture, the clinicians consistently overestimated the probability of GABHSP. Symptoms and signs predict GABHSP unreliably when used alone; they are helpful in modifying estimates of disease probability to facilitate optimal use of laboratory tests and antibiotics.

Acute Disease↗
PubMed2000

Pain and morbidity of transrectal ultrasound guided prostate biopsy: a prospective randomized trial of 6 versus 12 cores.

PURPOSE: An increasing number of studies suggest that 6-sector transrectal ultrasound guided biopsy of the prostate provides insufficient material to detect all clinically important prostate cancers and more cores may improve detection rates. We performed a prospective, randomized study to determine the effect of increasing the number of cores from 6 to 12 on pain and other morbidity associated with the biopsy procedure. MATERIALS AND METHODS: A total of 160 men (44 black, 28%) with a mean age plus or minus standard deviation of 65+/-8 years who had serum prostate specific antigen between 2.5 and 20.0 ng./ml. and/or digital rectal examination findings suspicious for cancer were prospectively randomized to undergo 6 or 12-core biopsy. Patients completed a self-administered questionnaire addressing pain and other morbidity before, and immediately and 2 and 4 weeks after biopsy. RESULTS: There was no difference between groups in mean pain scale with time for abdominal and rectal pain. For probe insertion, needle insertion and overall pain there was a significant increase in pain recalled at 2 which persisted at 4 weeks compared to immediately after biopsy. However, there was no difference for these 3 post-biopsy pain measures between the 6 and 12-core groups. In the 12-core group there was a statistically significant increase in hematochezia and hematospermia (24% versus 10%, p = 0.04 and 89% versus 71%, p = 0.01, respectively) but no significant difference between groups reporting morbidity as a moderate or major problem. There was no significant change in International Prostate Symptom Score, fever or hospitalization in the 12-core group. CONCLUSIONS: The 12-core prostate biopsy procedure is generally well tolerated and can be safely performed with no significant difference in pain or morbidity compared to the 6-core procedure.

Aged↗
PubMed2000

Induction of DNA replication in adult rat neurons by deregulation of the retinoblastoma/E2F G1 cell cycle pathway.

In adult organisms, a range of proliferative capacities are exhibited by different cell types. Stem cell populations in many tissues readily enter the cell cycle when presented with serum growth factors or other proliferative cues, whereas "terminally" postmitotic cells, such as cardiac myocytes and neurons, fail to do so. Although they rarely show evidence of a proliferative capacity in vivo, there is accumulating evidence to suggest that DNA synthesis can be triggered in postmitotic cells. We now show that cultured adult rat sensory neurons can replicate DNA in response to ectopic expression of E2F1 or E2F2 and that this is augmented by expression of cyclin-dependent kinase activities. We also find that addition of serum and laminin inhibits the E2F-induced S-phase in neurons but not in nonneuronal cells in the same cultures. We conclude that, although terminally differentiated neurons possess the capacity to reinitiate DNA replication in response to G1 regulatory activities, they fail to do so in the presence of signals that do not inhibit S-phase in other cell types in the same cultures. This suggests the existence of cell type-specific inhibitory pathways induced by these signals.

Adenoviridae↗
PubMed1999

Rapid arrest of axon elongation by brefeldin A: a role for the small GTP-binding protein ARF in neuronal growth cones.

Members of the ADP-ribosylation factor (ARF) family of small guanosine triphosphate-binding proteins play an essential role in membrane trafficking which subserves constitutive protein transport along exocytic and endocytic pathways within eukaryotic cell bodies. In growing neurons, membrane trafficking within motile growth cones distant from the cell body underlies the rapid plasmalemmal expansion which subserves axon elongation. We report here that ARF is a constituent of axonal growth cones, and that application of brefeldin A to neurons in culture produces a rapid arrest of axon extension that can be ascribed to inhibition of ARF function in growth cones. Our findings demonstrate a role for ARF in growth cones that is coupled tightly to the rapid growth of neuronal processes characteristic of developmental and regenerative axon elongation, and indicate that ARF participates not only in constitutive membrane traffic within the cell body, but also in membrane dynamics within growing axon endings.

ADP-Ribosylation Factors↗
PubMed1999

The effectiveness of rapidly infused intravenous fluids for inducing moderate hypothermia in neurosurgical patients.

UNLABELLED: Moderate hypothermia is often used for cerebral protection during anesthesia for cerebral aneurysm clipping. No reliable, rapid, and practical noncardiopulmonary bypass methods for the induction of hypothermia to core temperatures <34 degrees C have been reported. We assessed the effects of IV administration of chilled 5% albumin (5 mL/kg at 1-6 degrees C) on core temperature after surface cooling to approximately 34 degrees C. We calculated thermal distribution volume from the change in core temperature after the chilled fluid infusions. We also compared rapid administration (5 mL/kg over 30 min) with very rapid administration (5 mL/kg over 3-5 min). Chilled albumin 5 mL/kg infused over 5 min reduced core temperature by 0.6+/-0.1 degrees C. The same volume of chilled albumin infused over 30 min reduced core temperature by 0.4+/-0.1 degrees C. The calculated thermal distribution volume was less than one third of total body volume. Because the thermal distribution volume in these hypothermic patients was much lower than total body volume, the chilled IV fluids in this study were 3 times more effective in inducing hypothermia than suggested by a simple calculation. To achieve maximal effectiveness, however, chilled fluids must be administered very rapidly (>100 mL/min) to avoid heat gains in standard IV tubing that occur even with rapid administration. IMPLICATIONS: Chilled IV fluids can be much more effective for the induction of hypothermia than commonly assumed, but they must be administered very rapidly to avoid heat gains in IV tubing.

Aged↗
PubMed1999

Changes in family functioning for stroke rehabilitation patients and their families.

This study charted changes over time in the family functioning of a group of stroke rehabilitation patients and their families. Participants were 60 12-month stroke survivors who had undergone an inpatient rehabilitation programme, 46 spouses, and 25 other family members. Participants were assessed at the time of admission to and discharge from rehabilitation, and 6 and 12 months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Family functioning was assessed using the McMaster Family Assessment Device, and functional outcome was monitored with the competence scale of the Australian ADL Index. Longitudinal change in family functioning was observed in problem solving, family communication, role definition, behaviour control, and affective involvement. There were no significant differences between the family functioning ratings provided by patients and their spouses. It is important that consideration be given to means by which the increase in family dysfunction following stroke can be addressed.

Activities of Daily Living↗
PubMed1999

Correlates of dissatisfaction with treatment in patients with prostate cancer diagnosed through screening.

PURPOSE: We evaluated correlates of patient reported dissatisfaction with treatment of prostate cancer detected by screening. MATERIALS AND METHODS: We performed a cross-sectional retrospective study to evaluate the correlates of dissatisfaction with treatment in 1,651 patients in whom prostate cancer was detected through serial screening. We included demographic and clinical characteristics in the independent and control variables, and we validated measurements of quality of life outcomes. RESULTS: Overall 11% of patients were dissatisfied with the treatment received. Differences in the rates of dissatisfaction with treatment were not statistically significant across treatment groups (11% for retropubic radical prostatectomy, 21% for perineal radical prostatectomy, 14% for radiotherapy, 8% for observation, 8% for hormonal treatment and 4% for cryoablation, p = 0.1). Patient age, race, followup interval, marital status, education and co-morbid conditions were not significant correlates of dissatisfaction with treatment (for all characteristics p> or =0.05). Urinary function and bothersomeness were associated with dissatisfaction with treatment (p<0.0001), whereas sexual function and bothersomeness were not (p>0.05). Multivariate analysis revealed that urinary function and bothersomeness were also the only significant correlates of dissatisfaction with treatment. CONCLUSIONS: Of patients in whom prostate cancer was detected by screening 11% were dissatisfied with treatment. Urinary function and bothersomeness were the only important correlates of dissatisfaction.

Aged↗
PubMed1999

Universal surface scaling function for critical adsorption.

We present an accurate determination of the one- and two-phase universal surface scaling function which describes critical adsorption at noncritical interfaces of critical binary liquid mixtures in the strong surface field limit. The 95% confidence levels for this function are also determined. This function quantitatively describes ellipsometric critical adsorption data for three upper critical and one lower critical binary liquid mixtures.

Journal Article↗
PubMed1999

Psychological correlates of outcome following rehabilitation from stroke.

OBJECTIVES: To confirm, in a new sample, the value of our previously described procedure for identifying abnormal illness behaviour (AIB) in stroke rehabilitation patients, and to examine the relative effects of AIB, depression, family functioning, knowledge of stroke, and expectations of rehabilitation on long-term rehabilitation outcome. DESIGN: A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge. SETTING: The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. SUBJECTS: Sixty twelve-month stroke survivors, residing in a family environment, who had undergone an inpatient rehabilitation programme. MAIN OUTCOME MEASURES: AIB was assessed using the Illness Behaviour Questionnaire, depression with the Zung Self-Rating Depression Scale, family functioning with the McMaster Family Assessment Device, stroke knowledge with the Stroke Care Information Test, and expectations of rehabilitation with an open-ended question. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. RESULTS: Using our previously derived AIB classification rule, AIB cases scored poorly on functional, social and psychological indicators. Further, cluster analysis of discharge data replicated the rule for identifying patients with AIB. AIB was a strong predictor of functional competence and performance at rehabilitation discharge and both six and twelve months later, while depression was associated with an inactive lifestyle at both six and twelve months. Greater stroke knowledge and clearer expectations of rehabilitation were associated with better functional outcome at discharge. Family functioning was strongly associated with lifestyle activities and ADL performance at both six and twelve months. CONCLUSIONS: The procedure for identifying AIB in this rehabilitation environment appears to be robust. AIB was a key determinant of long-term functional disability, while depression was associated with poorer social functioning. Family functioning was an important determinant of social activities, and of the activities the patient actually does, rather than those the patient is capable of carrying out. Good stroke knowledge and clear expectations of rehabilitation were important determinants of rehabilitation success, and should be fostered to ensure a good rehabilitation outcome. Psychological factors are crucial in determining long-term outcomes after rehabilitation from stroke.

Activities of Daily Living↗
PubMed1999

Digital rectal examination for detecting prostate cancer at prostate specific antigen levels of 4 ng./ml. or less.

PURPOSE: We evaluated the detection rate of prostate cancer in men with suspicious digital rectal examination findings and serum prostate specific antigen (PSA) 4 ng./ml. or less. We also evaluated the stage and grade of cancers detected. MATERIALS AND METHODS: We screened 22,513 community volunteers by PSA testing and digital rectal examination at 6-month intervals. Biopsy was recommended when either test was suspicious for cancer. In the subset of 2,703 white and black men in whom PSA was 4 ng./ml. or less and digital rectal examination was suspicious for prostate cancer we compared compliance with biopsy recommendations, cancer detection rates, and stage and grade of cancers detected. We then correlated these results with patient age, race and serum PSA concentration. We performed multivariate logistic regression analysis to predict cancer based on clinical characteristics, and evaluated the positive predictive value of digital rectal examination for detecting cancer as stratified by race and PSA. RESULTS: Of the men 70% underwent biopsy with no difference in compliance according to age, race or PSA level. The 13% cancer detection rate correlated with age, race and PSA (p <0.003). The positive predictive value of a suspicious digital rectal examination was 5, 14 and 30% in men with PSA 0 to 1.0, 1.1 to 2.5 and 2.6 to 4.0 ng./ml., respectively. All cancers were clinically localized. Of the 72% of cases that were surgically staged 82% were organ confined and 78% were moderately differentiated. CONCLUSIONS: The positive predictive value of suspicious digital rectal examination was appreciable in men with low serum PSA. The majority of cancer cases detected by digital rectal examination had features of clinically important and potentially curable disease.

Aged↗
PubMed1999

Retrospective comparison of radical retropubic prostatectomy and 125iodine brachytherapy for localized prostate cancer.

PURPOSE: Favorable results with 125iodine (I) brachytherapy have been reported in select patients with localized prostate cancer. We evaluate the results of radical prostatectomy in patients matched for similar pretreatment clinicopathological characteristics. MATERIALS AND METHODS: From May 1983 to April 1998, 1 surgeon (W. J. C.) performed radical retropubic prostatectomy in 1,952 men (mean age plus or minus standard deviation 63+/-7 years), of whom 1,364 had Gleason score 6 or less on preoperative needle biopsy, a preoperative serum prostate specific antigen (PSA) value available and clinical stage T1 or T2 disease. We categorized all patients by preoperative Gleason score, preoperative PSA and clinical stage. For each Gleason score-by-PSA stratum we randomly selected by computer the number of men necessary to achieve the same overall distribution of clinical characteristics as in a series of patients treated with brachytherapy. All men were followed with semiannual PSA measurements and annual digital rectal examinations. Serum PSA greater than 0.3 ng/ml was considered evidence of cancer recurrence. Simple univariate statistics were used to compare clinical characteristics between series, and 7-year recurrence-free survival was estimated using Kaplan-Meier product limit estimates. To avoid a possible chance extreme result from 1 random sample we estimated 7-year recurrence-free survival in 5 computer selected random samples of our population. RESULTS: Mean 7-year recurrence-free survival was 84% (95% confidence intervals 78 to 89) for the radical prostatectomy series compared to 79% (confidence intervals not provided) for the 125I brachytherapy series. CONCLUSIONS: Radical prostatectomy yielded a proportionately but not statistically significant higher 7-year probability of nonprogression than 125I brachytherapy in patients with favorable clinicopathological characteristics. Comparisons are confounded by residual differences in clinicopathological features of tumors between groups and different treatment end points to determine outcomes. Further prospective, randomized clinical trials are required for valid comparisons.

Brachytherapy↗
PubMed1999

Clinical and pathological characteristics, and recurrence rates of stage T1c versus T2a or T2b prostate cancer.

PURPOSE: We compare clinicopathological features, and cancer recurrence and survival rates in men with stage T1c versus T2a or T2b prostate cancer. MATERIALS AND METHODS: From 1988 through 1998, 1 surgeon (W. J. C.) performed radical retropubic prostatectomy in 1,620 men with a mean age plus or minus standard deviation of 62.3 +/- 7 years. Clinical stage was T1c in 39%, T2a in 22% and T2b in 39% of patients. Patients were followed with semiannual prostate specific antigen (PSA) measurement and annual digital rectal examination. Serum total PSA greater than 0.3 ng./ml., histologically confirmed local tumor recurrence or distant metastases were considered evidence of cancer recurrence. Simple univariate statistics were used to compare clinical and pathological features by clinical stage, and multivariate Cox models were used to compare 5-year recurrence-free probabilities . The 5-year all cause and disease specific survival rates were calculated using Kaplan-Meier product limit estimates. RESULTS: Mean patient age was younger for the clinical stage T1c group (61 years) than for the T2a (62 years) or T2b (64 years) group. Mean preoperative PSA and the percentage of patients with biopsy Gleason score 8 to 10 were more favorable for the T1c (8 ng./ml., 3%) and T2a (7, 5%) groups than for the T2b group (11, 6%). Cancerous surgical margins, seminal vesicle invasion and lymph node metastases were also less frequent in the T1c (20, 5 and 0.8%, respectively) and T2a (23, 5 and 0.3%) groups than in the T2b group (29, 11 and 1.8%). The 5-year recurrence-free survival rate was 85% for T1c, 83% for T2a and 72% for T2b cases. Multivariate analysis indicated a decreased risk of recurrence for the T1c group compared to the T2a and T2b groups. The 5-year disease specific survival rate was 100% for the T1c and T2a groups, and 97% for the T2b group. CONCLUSIONS: Clinical and pathological features were similar for stages T1c and T2a, and different from stage T2b cancers. The 5-year recurrence-free survival was similar for T1c and T2a (log rank 0.89, p = 0.34), and higher than that for T2b (log rank 34.5, p <0.0001) cancers. However, controlling for all other prognostic factors on a Cox multivariate model, the risk of cancer recurrence was decreased for T1c compared to T2a and T2b disease. The detection of nonpalpable prostate cancer appears to be advantageous for intermediate-term cancer control.

Adult↗
PubMed1999

Potency, continence and complication rates in 1,870 consecutive radical retropubic prostatectomies.

PURPOSE: We update results in a series of consecutive patients treated with anatomic radical retropubic prostatectomy regarding recovery of erections, urinary continence and postoperative complications. MATERIALS AND METHODS: One surgeon performed anatomic radical retropubic prostatectomy on 1,870 men, using the nerve sparing modification when feasible. We evaluated recovery of erections and urinary continence in men followed for a minimum of 18 months. Patients who were not reliably potent before surgery, did not undergo a nerve sparing procedure, or received hormonal therapy or postoperative adjuvant radiotherapy were excluded from the analysis of potency rates but not of continence rates. Other postoperative complications were evaluated for the entire patient population. RESULTS: Recovery of erections occurred in 68% of preoperatively potent men treated with bilateral (543 of 798) and 47% treated with unilateral (28 of 60) nerve sparing surgery. Recovery of erections was more likely with bilateral than with unilateral nerve sparing surgery in patients less than 70 years old (71 versus 48%, p<0.001) compared with patients with age 70 years old or older (48 versus 40%, p = 0.6). Recovery of urinary continence occurred in 92% (1,223 of 1,325 men) and was associated with younger age (p<0.0001) but not with tumor stage (p = 0.2) or nerve sparing surgery (p = 0.3). Postoperative complications occurred in 10% of patients overall and were associated with older age (p<0.002) but the incidence declined significantly with increasing experience of the surgeon (p<0.0001). There was no operative mortality. CONCLUSIONS: Anatomic radical retropubic prostatectomy with the nerve sparing modification can be performed with favorable results in preserving potency and urinary continence. Better results are achieved in young men with organ confined cancer. Other complications can be reduced with increasing surgeon experience.

Adult↗
PubMed1999

Understanding external controls over the commercial introduction of engineered human tissues. Assessing regulatory and liability issues.

Emerging biomedical technologies present a new order of magnitude of complexity in their interactions with human patients. As such, they challenge established processes for protecting patients and the public health, while testing the capacity of those processes to ensure timely access to beneficial therapies--especially those representing significant advances over existing therapies. This article reviews the Food and Drug Administration (FDA) regulatory process--including the classification of medical products, the marketing review and approval pathways, and the 1997 FDA Modernization Act--and discusses other legal and policy considerations relevant to engineered tissues.

Biotechnology↗