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Biomedical subjects

J Wilder

Publications and source records attributed to J Wilder.

At least 19 recordsLinked to original sources
PubMed1997

Concerns and expectations in patients presenting with physical complaints. Frequency, physician perceptions and actions, and 2-week outcome.

BACKGROUND: Specific concerns and expectations may be a key reason that people with common physical complaints seek health care for their symptoms. OBJECTIVES: To determine the frequency of symptom-related patient concerns and expectations, physician perceptions and actions, and the relationship of these factors to patient satisfaction and symptom outcome. METHODS: This was a prospective cohort study of 328 adult outpatients presenting for evaluation of a physical complaint. The setting was a general medicine clinic in a teaching hospital. Measures included previsit patient questionnaire to identify symptom-related concerns and expectations; a postvisit physician questionnaire to determine physician perceptions and actions; and a 2-week follow-up patient questionnaire to assess symptom outcome and satisfaction with care. RESULTS: Pain of some type accounted for 55% of common symptoms, upper respiratory tract illnesses for 22%, and other physical complaints for 23%. Two thirds of patients were worried their symptom might represent a serious illness, 62% reported impairment in their usual activities, and 78%, 46%, and 41% hoped the physician would prescribe a medication, order a test, or provide a referral. Physicians often perceived symptoms as less serious or disabling and frequently did not order anticipated tests or referrals. While symptoms improved 78% of the time at 2-week follow-up, only 56% of patients were fully satisfied. Residual concerns and expectations were the strongest correlates of patient satisfaction. CONCLUSIONS: Improved recognition of symptom-related concerns and expectations might improve satisfaction with care in patients presenting with common physical complaints.

Activities of Daily Living↗
PubMed1995

Simultaneous better than sequential for brief presentations.

During perceptually intensive tasks such as reading, there is a bottleneck in the information transfer between the large number of alphanumeric characters available and the acquiring of these characters. This is due mainly to the limited number of characters that one can report at a glance (also known as the "magic number 7 +/- 2") [Psychol. Rev. 63, 81 (1956)]. To examine where in the perceptual pathway this bottleneck occurred, several investigators tested and compared performance with simultaneous and with sequential target presentations [J. Exp. Psychol. 79, 1 (1969); 93, 72 (1972); Percept. Psychophys. 14, 231 (1973)]. They found that performance was nearly equal in the two cases and concluded that the bottleneck must be due to the limitation of short-term memory. However, these studies were limited either by a long stimulus-onset asynchrony (SOA), or time interval between onsets of icon presentations, or by a lack of poststimulus masking. We report on experiments designed to overcome these limitations. We used shorter SOA's than did previous investigators, and we removed persistence effects by poststimulus masking. Our stimuli were presented either sequentially or simultaneously. For the sequential presentation a numeral ranging from 0 to 9 was displayed at any one of eight positions 1.5 deg from a central fixation cross. The appearance of the next numeral in another part of the display coincided with the masking of the previous numeral. This was done for trials of one to four numerals and SOA's of 16.7, 33.3, and 50.0 ms.(ABSTRACT TRUNCATED AT 250 WORDS)

Attention↗
PubMed1995

Context effect of common objects on visual processing.

In previous experiments on visual processing it was shown that correct identification of sequentially and simultaneously presented numerals declined as the presentation interval was decreased from 50.0 to 16.7 ms/numeral. To determine how performance was influenced in context, common everyday objects were used in place of the numerals. These objects were grouped into 36 different categories with 4 objects per category. An example of a category was fruit: apple, banana, pear, pineapple. For all experimental trials, objects (ranging in number from one to four) were presented randomly at four possible positions 1.5 degrees from a central fixation point. In a sequential trial, the objects were displayed in succession at different locations for a stimulus onset asynchrony (SOA) of either 16.7, 33.3, or 50.0 ms. The masking of a previous object coincided with the onset of the object that followed in the sequence. A simultaneous trial consisted of 2, 3, or 4 objects presented concurrently. For these trials, simultaneous masking occurred at SOA's of 16.7, 33.3, or 50.0 ms. For both experimental paradigms, one-half of the trials consisted of objects from the same category, and one-half from mixed categories. Results taken from four observers showed that performance for all three SOA's was consistently better when the objects were related as opposed to when the objects were not for both presentation protocols. This lent support to the theory that there was simultaneous interaction of top-down and bottom-up processes in visual processing. In addition, as was found in the numerals study, performance was better when the objects were presented simultaneously as opposed to sequentially.

Adult↗
PubMed1992

Activation of B lymphocytes by NK cells.

The ability of NK cells to induce differentiation of B lymphocytes to IgM secretion in vitro has been investigated. Homogeneous preparations of NK cells obtained from IL-2 propagated splenocytes from SCID mice were found to have the ability to induce resting B lymphocytes to proliferate and secrete significant amounts of IgM. The induction is greatly enhanced by the presence of both IL-2 and IL-5 and does not require T lymphocytes or adherent cells in the responding population. Cell contact between the two populations is not necessary suggesting that the effect is mediated by soluble factor(s) which can be produced even by irradiated NK cells. Because the activity cannot be replaced by either r-tau-IFN or tumor necrosis factor-alpha or inhibited by antibodies to these lymphokines, a novel NK cell-derived factor(s) may be involved. The implications of this interaction between NK cells and B lymphocytes are discussed.

Animals↗
PubMed1991

Kaposi sarcoma associated with human immunodeficiency virus infection.

In the present study, 11 patients with epidemic Kaposi sarcoma were evaluated; 55% were in stage IV and 45% in stage II; in addition, 75% had systemic symptoms, 89% had low total and T-lymphocyte counts, and all of them had not only low T-helper lymphocyte counts but also T-helper/T-suppressor ratios. The majority of patients (89%) had low proliferative responses with phytohemagglutinin (PHA). Nine patients were treated with: alpha-2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha-2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts. In May 1989, 73% of patients were dead (median survival 8 +/- 2 months). It is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with alpha-2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low T-helper/T-suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts.

Adult↗
PubMed1990

Role of intracavitary cuff boost after adjuvant external irradiation in early endometrial carcinoma.

Management of early endometrial carcinoma often consists of surgicopathologic staging followed by adjuvant radiation therapy (RT) for patients at risk of local recurrence. While an intracavitary vaginal cuff boost (VCB) is commonly given after external beam radiation therapy, its effects on local control and complication rates are unknown. To assess these effects, we reviewed 157 patients with FIGO Stage I (n = 134) or incidentally diagnosed (n = 23) endometrial adenocarcinomas. After surgery and external radiation therapy, 103 patients (65.6%) received a vaginal cuff boost of 3000-5000 cGy surface dose (Group I) and 54 (34.4%) did not (Group II). One hundred and two Group I and 52 Group II patients were evaluable for analysis. Median follow-up was 78.0 months for Group I and 60.0 months for Group II. Despite a preponderance of poor prognostic factors in Group II, no significant difference in local failure was seen. A component of local failure was seen in 6 Group I patients (6.0%) and 4 Group II patients (7.7%), p = 0.74. Distant failure, reflecting more advanced disease, was higher in Group II (19.2%) than in Group I (9.0%). Late complications included rectal bleeding/proctitis in 18.6% of Group I patients and 3.8% of Group II patients (p = 0.01). Overall, grade 2 complications occurred in 27.5% and 15.4% of Group I and II patients, respectively (p = 0.09). No difference in frequency of grade 3 complications was evident. Based on this retrospective study, intracavitary vaginal cuff boost after surgery and postoperative external beam radiation therapy does not appear to improve local control in early endometrial adenocarcinoma. Its possible effect on complication rates is uncertain.

Adult↗
PubMed1989

Analysis of failure patterns in stage III endometrial carcinoma and therapeutic implications.

The poor outcome of certain patients with Stage III endometrial carcinoma has led some investigators to direct adjuvant therapy to the abdominal cavity. To better define failure patterns, a review of 126 patients with Stage III endometrial carcinoma treated at four institutions was performed. Seventy-four patients were diagnosed at surgery with pathologic Stage III disease, whereas 52 patients presented with clinical Stage III disease. Most patients received external beam irradiation to the pelvis with a variety of boost techniques. Site of disease, grade, depth of invasion, and pathology were examined for prognostic significance. Actuarial techniques were used to analyze survival and recurrences. For the 52 clinical Stage III patients, 5-year survival was 36%. The median survival of 20 patients who were treated with radiation therapy (RT) following biopsy was 9 months. Pelvic control was poor in these patients, with 16/18 evaluable patients failing locally. Thirty-two patients who underwent resection with adjunctive RT had a 5-year survival of 48%. Local failure occurred in 40% of patients, whereas 38% of patients had abdominal failure. Isolated abdominal failure was infrequent with 6% failing as isolated recurrence, and 16% failing as the only site of distant disease. For 74 pathologic Stage III patients, 5-year survival was 54%. Local failure resulted in 20% of patients, and isolated abdominal failure occurred in 7% of patients. The subset of patients with ovarian or tubal involvement included 42 patients, with a 5-year survival of 60%. Further analysis of this subset by grade and depth of myometrial penetration was found to be prognostically significant. Twenty-four patients who were Stage III because of parametrial or pelvic peritoneal involvement had a 5-year survival of 44%. Local control and survival is improved in Stage III patients treated with surgical resection. The high rate of distant metastases in both abdominal and extra-abdominal sites has significant therapeutic implications.

Adult↗
PubMed1977

Male and female: the significance of values.

Women's personal values as well as societal values regarding them have been undergoing significant changes. This trend is supported by recent rapid technological advances reaching into home and working place, by the development of birth-control measures and of treatment for venereal diseases, and by women's easier access to education and careers.

Culture↗
PubMed1975

The lure of magic thinking.

The development of the thinking processes from childhood to maturity is analyzed and three stages are distinguished: the magic omnipotent stage of the preschool child, the development of the realistic ego, and the future-directed value-building superego. The role of the lure to return to the magic thinking in our culture is described.

Age Factors↗