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Biomedical subjects

J Spicer

Publications and source records attributed to J Spicer.

At least 19 recordsLinked to original sources
PubMed2001

Professional lability insurance: I. A historical perspective.

Medical professional liability insurance (also known as malpractice insurance) is designed specifically to protect physicians, clinics, hospitals and health care facilities, and other health personnel in the event that a patient files a claim against them, alleging negligence, with resulting injury or harm. It is one of the largest expenses for any medical practice and is a high priority concern of every physician. The market for this insurance, the approach to evaluating it, and the cost of it have changed dramatically in the last 20 years.

History, 20th Century↗
PubMed2000

Theoretical perspectives on suicide in gay men with AIDS.

Suicide among gay men with AIDS constitutes a significant theoretical and practical problem. In order to understand this problem it is necessary to consider the specific circumstances that surround these individuals. Whilst there are many theories of suicide with which to address the problem, few are able to capture the special context within which gay men with AIDS live. This article explores three broad concepts from the theoretical literature on suicide that have explanatory potential in this unique context. The three concepts are: the search for meaning in the midst of suffering, Shneidman's [Shneidman, E., 1985. Definition of Suicide. John Wiley, New York] notion of unendurable psychological pain, and hopelessness. This article attempts to demonstrate how these three concepts can incorporate the experiences of gay men with AIDS and contribute to understanding the problem of suicide in this population.

Acquired Immunodeficiency Syndrome↗
PubMed1999

The mouse Peutz-Jeghers syndrome gene Lkb1 encodes a nuclear protein kinase.

The protein kinase gene LKB1 has recently been identified as the gene mutated in the Peutz-Jeghers cancer predisposition syndrome. This condition is characterized by inherited susceptibility to a range of cancers but in particular those of the gastrointestinal tract. Here we have characterized the mouse Lkb1 gene. The mouse Lkb1 gene consists of 10 exons covering approximately 15 kb in length, maps to mouse chromosome 10 and encodes a protein showing strong sequence similarity to human LKB1. The 3" end of Lkb1 in the mouse is in very close proximity to the 3" end of an apparently unrelated gene R29144/1 and it seems probable that overlapping transcripts of the two genes are produced. Using transfection of Lkb1 cDNAs we have shown that Lkb1 is most likely a nuclear protein and have defined a nuclear localization signal within the protein sequence. Thus the defect in Peutz-Jeghers syndrome may directly result in changes in gene expression in the nucleus of target cells.

AMP-Activated Protein Kinases↗
PubMed1999

A new measure of conversational experience: the speaking extent and comfort scale (SPEACS).

Few measures exist which directly assess aspects of conversational experience. We present and provide a psychometric assessment of the Speaking Extent and Comfort Scale (SPEACS), a new 20-item measure which assesses four aspects of past conversational experience: the extent and comfort of both general conversations and in conversations specifically about the self. All four SPEACS subscales exhibited good test-retest reliability. As predicted, the subscales related positively to social competence, disclosure, assertiveness, and perceived availability of someone to talk to, and negatively to social avoidance and social anxiety, providing support for their construct validity. Internal consistency data demonstrated that people tend to vary in how often and how comfortable they feel having conversations with different people. SPEACS offers a range of potential applications in areas with a focus on social networks, social experience and interaction, and the possibility of extension to other dimensions of conversational experience.

Adolescent↗
PubMed1999

Development of a radiopharmaceutical information database.

OBJECTIVE: This article describes the development of a radiopharmaceutical (RP) computer database. Development and implementation of the database and services provided are presented. METHODS: A commercial database program was used to develop the structure for a radiopharmaceutical information database (RID) and to classify interaction information into several categories. The database is accessible to a variety of users through a network server. RESULTS: Information entered into the RID may be accessed easily and rapidly. The RID provides a wide spectrum of information services to its customers. CONCLUSION: The RID described is the first attempt to develop a database capable of entry and retrieval of RP information in an efficient and timely manner. The database is easy to use and maintain, and has virtually unlimited storage space on a network drive.

Database Management Systems↗
PubMed1998

Treatment of patients with transitional-cell carcinoma of the urothelial tract with ifosfamide, paclitaxel, and cisplatin: a phase II trial.

PURPOSE: A phase II trial of ifosfamide, paclitaxel, and cisplatin (ITP) was conducted in previously untreated patients with advanced transitional-cell carcinoma (TCC) to assess its efficacy and toxicity. PATIENTS AND METHODS: Thirty patients with metastatic or unresectable TCC were treated with ifosfamide 1.5 g/m2/d for 3 days with paclitaxel 200 mg/m2 over 3 hours and cisplatin 70 mg/m2 on day 1 of each 28-day treatment cycle. Therapy was continued for a maximum of six cycles. Prophylactic hematopoietic growth factor (recombinant human granulocyte colony-stimulating factor [rhG-CSF]) was given on days 6 to 17 of each cycle. RESULTS: Twenty-three of 29 assessable patients (79%; 95% confidence interval [CI], 60% to 92%) demonstrated a major response (six complete [CR] and 17 partial [PR]) with response durations that ranged from 5 to 24+ months. Five patients with T4 bladder primary tumors had a major response, two with pathologic CR. At a median follow-up duration of 17.9 months, nine (31%) patients remain disease-free (range, 10+ to 24+). Hematologic toxicity included anemia, thrombocytopenia, and neutropenia; febrile neutropenia was observed in 17% of patients and 4% of cycles. No grade 4 nonhematologic toxicity was observed. Grade 3 nonhematologic toxicity included alopecia, allergy (3%), renal insufficiency (13%), and neuropathy (10%). Dose reductions or drug omissions were necessary for adverse events in seven (23%) patients. CONCLUSION: ITP is an active, well-tolerated regimen in previously untreated patients with TCC of the urothelial tract. Further study of this regimen in patients with both TCC and non-transitional-cell urothelial tumors is ongoing.

Adult↗
PubMed1997

Long-term follow-up of patients with good-risk germ cell tumors treated with etoposide and cisplatin.

PURPOSE: To assess the durability of response and overall survival for patients with good-risk metastatic germ cell tumors (GCT) treated with four cycles of etoposide and cisplatin (EP). PATIENTS AND METHODS: Two hundred fourteen patients treated with EP on two consecutive randomized trials for good-risk metastatic GCT were the subject of this retrospective study. The response to therapy, relapse and survival status, and results of salvage therapy are reported. RESULTS: One hundred ninety-five patients (91%) achieved a complete response (CR). This included 182 patients (85%) who achieved a CR to chemotherapy alone and 13 patients (6%) who achieved a CR to chemotherapy plus surgical resection of viable GCT. Seventeen patients (9%) have relapsed from CR. The median time to relapse was 10 months, and the longest duration from treatment to relapse was 36 months in a patient who received three of four planned courses of therapy. Eight patients who either achieved an incomplete response (IR) or relapsed were rendered continuously disease-free by salvage therapy and are alive. One hundred eighty-three patients (86%) are alive at a median follow-up of 7.6 years. CONCLUSION: Four cycles of EP constitute effective therapy and can be offered to patients with good-risk GCT. In patients with intermediate- and poor-risk GCT, clinical trials remain a priority to identify more effective treatment.

Adolescent↗
PubMed1996

Cynical hostility, anger, and resting blood pressure.

Research on associations of anger and hostility with resting blood pressure (BP) has generally ignored their interrelationships. The present study examined the individual and joint relationships of cynical hostility, anger-in, anger-out, and anger frequency with resting BP using the Cook-Medley Hostility Scale and the Spielberger anger scales. Multiple regressions were conducted on data from a community sample of 105 men and women to examine the main and interactive effects of anger and hostility on BP, controlling for established physical covariates. Diastolic BP was inversely related to anger-in scores in men and women. Systolic and diastolic BP were positively associated with Ho (hostility) score only in women. No confounding or interactive effects of hostility and anger on BP were found. It is suggested that the sex-specific link between cynical hostility and BP may reflect a chronic mismatch between the social cognitions of cynically hostile women and some of the cultural norms that govern women's social lives.

Adult↗
PubMed1995

Categorisation of the patient's medical condition--an analysis of nursing judgement.

This paper is a report of a study designed to explore the way in which community and hospital based nurses categorised 35 medical conditions. The results, obtained from a series of card-sorts using a Multiple Sorting Task and a modified Q-Sort, found that nurses used four global sub-categories of severity to categorise them. The findings provided a basis for an analysis of nursing assessment and established that they were realised as prognostic judgements. Discussion of the structure of the categories led to a possibility that the cognitive skill referred to as 'intuition' could be explained by the way in which clinical knowledge comes to be organised in memory.

Adult↗
PubMed1995

Criteria for breast reconstruction surgery: another viewpoint.

A more articulated model than now exists for shaping criteria for breast reconstructive surgery can be drawn from an examination of the criteria followed by museums for treating work of art. This article characterizes the challenge for oncologists and general surgeons to convey usable information to women facing a mastectomy and propose a model for making these decisions on the basis of an art museum curator's assessment of the appropriate degree of restoration for a range of damaged works of art.

Art↗
PubMed1994

Self management practices in adult asthmatics.

AIM: To examine how adherence to medications and use of competencies (eg, avoiding personal precipitants and managing an acute attack) vary by age, sex, education and number of symptoms in a sample of adult asthmatics. METHODS: 412 adult asthmatics, members of two asthma societies, participated in a mailed survey. The questionnaire contained measures of asthma medication adherence, asthma health competencies, asthma symptoms, and demographic characteristics. RESULTS: Older asthmatics were more likely to adhere and to use more competencies. Females used more competencies than males. Asthmatics with higher numbers of symptoms used more competencies. No differences were found by educational level. CONCLUSIONS: Better adherence in older asthmatics may be due to their having developed greater recognition of the efficacy of medications. The more extensive use of competencies by older people and by women reflects previous findings that these groups value health more and engage in less health threatening behaviours in general. The results also suggest that experiencing asthma symptoms motivates better self management practices. The study raises awareness of the role of competencies in controlling asthma, and should assist health professionals to identify specific differences in self management.

Adult↗