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Biomedical subjects

J A Turner

Publications and source records attributed to J A Turner.

At least 19 recordsLinked to original sources
PubMed1992

Patient outcomes after lumbar spinal fusions.

OBJECTIVES: To determine success and complication rates for lumbar spinal fusion surgery, predictors of good outcomes, and whether fusion improves success rates of laminectomy for specific low back disorders. DATA SOURCES: English-language journal articles published from 1966 through April 1991, identified through MEDLINE searching (spinal fusion plus limiting terms), bibliography review, and expert consultation. STUDY SELECTION: Articles were selected only if they reported at least 1 year of follow-up data enabling the classification of clinical outcomes as satisfactory or unsatisfactory for at least 30 patients. DATA EXTRACTION: Two reviewers independently extracted data on patient characteristics, surgical methods, patient outcomes, and quality of study methods. DATA SYNTHESIS: Of 47 articles, there were no randomized trials. Four nonrandomized studies compared surgery with and without fusion for herniated disks; three found no advantage for fusion. On average, 68% of patients had a satisfactory outcome after fusion, but the range was wide (16% to 95%), and the satisfactory outcome rate was lower in prospective than in retrospective studies. The most frequently reported complications were pseudarthrosis (14%) and chronic pain at the bone graft donor site (9%). Clinical outcomes did not differ by diagnosis or fusion technique, but were worse in studies with a greater number of previously operated patients. CONCLUSIONS: For several low back disorders no advantage has been demonstrated for fusion over surgery without fusion, and complications of fusions are common. Randomized controlled trials are needed to compare fusion, surgery without fusion, and nonsurgical treatments in rigorously defined patient groups.

Adult↗
PubMed1992

Sequential analysis of chronic pain behaviors and spouse responses.

Social reinforcers such as spouse behaviors have been hypothesized to be important in maintaining chronic pain behavior. This study used direct observation to test whether solicitous and aggressive spouse behaviors systematically precede and follow patient pain behaviors. Fifty chronic pain patients and spouses and 33 control couples were videotaped performing specified tasks. Spouse solicitous behaviors were significantly more likely to precede and follow nonverbal pain behaviors, and nonverbal pain behaviors were significantly less likely to follow spouse aggressive behaviors in pain than in control couples. Within couples, spouse solicitous behaviors preceded and followed verbal and nonverbal pain behaviors beyond chance levels more often in pain than in control couples. Results support an operant conceptualization of factors maintaining chronic pain behaviors.

Adult↗
PubMed1992

Does the Millon Behavioral Health Inventory (MBHI) predict lumbar laminectomy outcome? A comparison with the Minnesota Multiphasic Personality Inventory (MMPI).

Response to surgery for low-back pain is influenced by psychosocial as well as physical factors. However, no psychosocial measure has yet been found to be highly accurate in predicting surgical outcome for individual patients. The purpose of this prospective study was to assess the usefulness of the Millon Behavioral Health Inventory (MBHI) in predicting outcome of laminectomy for lumbar disc herniation or spinal stenosis. Its use was compared with that of the Minnesota Multiphasic Personality Inventory. The influence of several demographic, clinical, and radiographic variables was also investigated. One hundred twenty-seven patients were assessed at an average of 24 months postsurgery. Ninety-three patients had a good outcome, 20 had a fair outcome, and 14 had a poor outcome. The MBHI scales as a group were not associated with surgical outcome.

Evaluation Studies as Topic↗
PubMed1992

Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature.

A meta-analysis was undertaken to determine the effects of surgery for lumbar spinal stenosis on pain and disability. Seventy-four journal articles met inclusion criteria and were independently reviewed by two readers. On average, 64% of patients treated surgically for lumbar spinal stenosis were reported to have good-to-excellent outcomes. However, there was wide variation across studies in the percentage with good outcomes. Few patient characteristics were found to predict outcome. Major deficits in study design, analysis, and reporting were common, and these precluded firm conclusions.

Adult↗
PubMed1992

Nursing care of the terminal lung cancer patient.

Care of the terminal lung cancer patient will be more effective when a multidisciplinary approach is used. Planning for terminal care should not be delayed until the last few hours or days of life. Hospice care offers the terminal lung cancer patient an alternative to dying in a hospital or nursing home. Caring support to alleviate pain and prevent suffering is the goal of nursing care for the terminal cancer patient. Nursing interventions should be directed toward allowing the patient to retain decision-making authority in care for as long as possible.

Ethics, Nursing↗
PubMed1991

MMPI short forms as predictors of response to conservative treatment for low back pain.

This study (N = 115) compared the abilities of the Faschingbauer Abbreviated Minnesota Multiphasic Personality Inventory (FAM), the Midi-Mult, and the standard MMPI to predict response to conservative medical treatment for low back pain, as assessed by patient ratings of pain intensity 6 to 12 months later. The results indicated that all three inventory formats yielded significant correlations between the Hypochondriasis, Depression, and Hysteria scales and follow-up pain ratings. Less consistent findings were obtained with other scales and indices. The results provide tentative support for the clinical and research utility of these abbreviated MMPIs in substituting for the standard MMPI in outcome studies with back pain patients.

Adolescent↗
PubMed1991

Chronic pain in primary care. Identification and management of psychosocial factors.

Chronic pain is a problem of great public health importance that is frequently seen in the primary care setting. Pain chronicity shows a strong association with psychosocial factors. Assessment of these factors should be composed of two parts: (1) psychological factors and (2) psychiatric illness. Psychological factors include all those pain-associated alterations in the patient's environment that reinforce illness behavior. Psychiatric illness includes those syndromes that retard recovery from illness or injury, such as depression, anxiety, substance abuse, and dementia. Psychiatric and psychological interventions can be successfully introduced in the context of a comprehensive rehabilitation effort. Usually these interventions can be accomplished by the family physician in concert with a consultant psychiatrist or psychologist. In severely disabled or resistant patients, referral to a multidisciplinary pain clinic will be necessary.

Acute Disease↗
PubMed1990

Interpersonal types among alcohol abusers: a comparison with drug abusers.

Interpersonal types among alcohol abusers were examined with Calsyn, Roszell, and Anderson's (1988) nine-type system for classifying FIRO-B profiles. The frequencies of the nine FIRO-B types among a sample of 135 male veteran alcohol abusers were compared with Calsyn et al.'s (1988) previously published data for a sample of male veteran drug abusers, a normative veteran sample, and a general population sample. The alcohol abusers, like Calsyn et al.'s sample of drug abusers, were more likely to be categorized as "loners," "rebels," and "pessimists" than was the general population sample. While exhibiting preferences for interpersonal types that emphasized social withdrawal, avoidance of responsibility, and mistrust of others, both the alcohol abusers and the drug abusers were heterogeneous groups whose members demonstrated a variety of interpersonal types.

Adult↗
PubMed1990

Effectiveness of behavioral therapy for chronic low back pain: a component analysis.

The effects of outpatient group behavioral therapy including aerobic exercise (BE), behavioral therapy only (B), and aerobic exercise only (E) on pain and physical and psychosocial disability were evaluated and compared in a group of mildly disabled chronic low-back-pain patients. Ninety-six Ss were randomly assigned to the 3 treatments and a waiting-list control (WL) condition and assessed on a variety of patient self-report, spouse-rated, and direct observational measures at pretreatment, posttreatment, and 6- and 12-month follow-ups. Patients in the BE condition, but not the B or E conditions, improved significantly more pretreatment to posttreatment than did WL patients on the patient self-report and observer-rated measures. At both follow-ups, all 3 treatment groups remained significantly improved from pretreatment, with no significant differences among treatments.

Adult↗
PubMed1990

Late versus early onset problem drinking in older men.

Age at onset of problem drinking was studied in 132 older men (age 60 years and older) admitted to a VA geriatric alcoholism outpatient treatment program. Demographics, alcohol history, self reported psychological status, special treatment, and treatment compliance variables were tested for association with onset age. Late onset (defined as onset of the first alcohol problem at or after age 60) was not uncommon, occurring in 15% of the sample (29% of patients age 65 or older). Compared to earlier onset cases, late onset alcohol problems were milder and more circumscribed, and were associated with less family alcoholism and greater psychological stability. Late onset patients were also more compliant with outpatient treatment requirements; however, treatment program variables were better predictors of compliance than onset age.

Age Factors↗
PubMed1990

A murine fer testis-specific transcript (ferT) encodes a truncated Fer protein.

A cDNA for a potential tyrosine kinase-encoding mRNA was isolated from a mouse testis cDNA library. In a survey of eight mouse tissues, a transcript of 2.4 kilobases restricted to testis tissue was found. The mRNA encodes a 453-amino-acid protein of 51,383 daltons, the smallest tyrosine kinase protein ever described. RNA synthesized from the cDNA template directs the synthesis of a 51,000-Mr protein in a cell-free translation system. The carboxy-terminal 409 amino acids are 98 and 90% identical to the carboxy halves of the rat and human Fer proteins, respectively. This suggests that the cDNA represents an alternatively spliced testis-specific fer mRNA and is therefore termed by us ferT. On the basis of the appearance time of the fer mRNA in the testis of maturing neonatal mice, we speculate on the role played by this protein in the development of this organ.

Amino Acid Sequence↗
PubMed1990

Cardiovascular trauma.

Cardiac trauma affects people of all ages from all walks of life. The exact incidence of cardiac trauma is unknown because many individuals die before ever reaching a medical facility for treatment. Reduction in the time from cardiac injury to definitive treatment with continued improvement in rapid emergency transport systems will result in a lower mortality rate. The challenge for nursing is to reduce mortality of victims of cardiac trauma further with prompt nursing diagnosis and effective nursing interventions.

Aorta, Thoracic↗
PubMed1988

Use of the MMPI and MCMI in predicting outcome of lumbar laminectomy.

This study compared the abilities of the MMPI and Millon Clinical Multiaxial Inventory (MCMI), using discriminant analyses, to predict outcome after lumbar laminectomy for chronic back pain. Sixty-nine males and 60 females with lumbar discogenic disease completed MMPIs and MCMIs before surgery and were classified as either having good or fair/poor surgical outcomes based on self-reported pain relief, return to work, restriction of activities, and medication use. Results showed both the MMPI and MCMI to have moderate ability to predict surgery outcome. A slightly higher classification hit rate was obtained with both instruments when age, sex, employment status, and presence of compensation/litigation issues also were entered into the prediction equation. Results indicate the need for caution in using either instrument to make predictions of surgery outcome in individual cases.

Adolescent↗
PubMed1988

In vivo pharmacological studies with SK&F 94836, a potent inotrope/vasodilator with a sustained duration of action.

1. SK&F 94836 (racemate) was studied in vivo for its cardiovascular properties in cats and dogs. 2. In anaesthetized cats and dogs SK&F 94836 administered intravenously caused increases in left ventricular contractility and decreases in peripheral vascular resistance at similar doses, thus demonstrating the compound to be a mixed acting positive inotropic/vasodilator agent. 3. In conscious instrumented dogs SK&F 94836 was active via the oral as well as intravenous route. 4. The inodilator activity of SK&F 94836 in conscious and anaesthetized animals occurred in association with minimal changes in either blood pressure or heart rate. 5. Detailed studies carried out on anaesthetized cats indicated that SK&F 94836 caused a balanced dilatation of both resistance and capacitance blood vessels. 6. Haemodynamic studies in anaesthetized cats indicated that as a consequence of the inotropic/vasodilator actions, SK&F 94836 caused significant increases in cardiac output and stroke volume. 7. Detailed studies in anaesthetized dogs indicated that significant inodilator activity occurred in the absence of an increase in myocardial oxygen consumption. 8. The duration of action of SK&F 94836 was sustained following both i.v. and oral administration. 9. We conclude that SK&F 94836, as an orally active inotropic/vasodilator agent with a sustained duration in vivo, has potential utility in the treatment of congestive heart failure.

Anesthesia↗
PubMed1988

Physical fitness and chronic low back pain. An analysis of the relationships among fitness, functional limitations, and depression.

The purpose of this study was to describe the associations between physical fitness and important aspects of chronic low back pain problems, specifically, pain, depression, physical dysfunction, and psychologic dysfunction. Ninety-six persons with chronic low back pain were evaluated with a battery of physical and psychologic disability measures and basic physical fitness tests for aerobic capacity, strength, and flexibility. Greater overall physical fitness was significantly correlated with less physical dysfunction (R = -0.48) and fewer depressive symptoms (multiple R = -0.42), but not with psychologic dysfunction (R = -0.20) or pain (R = -0.20). Fitness accounted for 23% of the variance in physical dysfunction and 17% of the variance in depression in this mildly dysfunctional chronic back pain patient sample. Strength, as compared with aerobic capacity or flexibility, was the fitness variable contributing most to these observed associations.

Activities of Daily Living↗
PubMed1988

Lumbar disc herniations: the predictive value of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI).

Ninety-one patients who were treated for lumbar disc herniation with chymopapain chemonucleolysis were evaluated preoperatively by means of the Health Attribution Test (HAT) and the Minnesota Multiphasic Personality Inventory (MMPI). There were 54 good, 10 fair, and 27 poor results after chemo-nucleolysis. Nineteen patients subsequently underwent lumbar laminectomy and discectomy and the ultimate outcome for the entire series including these laminectomy patients was 66 good, 10 fair, and 15 poor results. The fair/poor chemonucleolysis outcome patients scored significantly lower than did the good outcome patients on the HAT Powerful Others and significantly higher on the Chance scale. Patients with fair or poor outcomes after chemonucleolysis only scored significantly higher on the Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, and Hypomania scales in preoperative MMPI testing. Good versus fair/poor ultimate outcome patients differed significantly on preoperative MMPI Hypochondriasis, Hysteria, Psychopathic Deviate, Paranoia, Psychasthenia, Schizophrenia, Hypomania, and Social Introversion scales. These groups also differed significantly on preoperative HAT Internal and Chance scales. Further analyses found the MMPI to be a slightly better predictor of chemonucleolysis outcome and much better predictor of ultimate outcome than the HAT.

Adolescent↗