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Biomedical subjects

S Simms

Publications and source records attributed to S Simms.

17 recordsLinked to original sources
PubMed2000

Hypofractionated moderate dose radiation, intrathecal chemotherapy, and repetitive reinduction/reconsolidation systemic therapy for central nervous system relapse of acute lymphoblastic leukemia in children.

BACKGROUND: We assessed efficacy and morbidity of chemotherapy and 1, 800 cGy of hypofractionated craniospinal irradiation (CSI) in children with central nervous system (CNS) relapse following first remisssion of acute lymphoblastic leukemia (ALL). PROCEDURE: Nineteen patients with isolated CNS relapse and 4 with combined CNS/marrow or CNS/testicular relapse received treatment according to Children's Hospital of Philadelphia (CHOP) protocols CHP-449 and CHP-497. CNS treatment included intrathecal methotrexate, cytarabine, and hydrocortisone and 1,800 cGy CSI in 16 fractions over 12 months. Systemic therapy consisted of reinductions with vincristine, prednisone, and daunorubicin and reconsolidations with cytarabine, etoposide, and L-asparaginase every 56 days for 2 years. Outcome measures were event-free survival (EFS), survival, growth, and neuropsychologic assessment or school performance. RESULTS: Follow-up of survivors from first relapse ranges from 52 to 133 months(median 91 months). Actuarial survival and EFSat 10 years are 58% (CI95 = 38-78%) and 54% (CI95 = 32-76%). Events include 2 second CNS, 4 marrow, 1 testicular, and 2 testicular/marrow relapses and 1 secondary leukemia. EFS is 100% (CI95 = 93-100%) in 9 patients with recurrence more than 26 months from diagnosis. Three patients have significant treatment-related reduction in stature. Median full-scale IQs of 6 patients tested were 112 pretreatment and 111 posttreatment among surviving patients. All 17 survivors attend regular school, but 2 receive supplementary special services. CONCLUSIONS: Lower dose, hypofractionated CSI, intrathecal chemotherapy, and moderately intensive systemic chemotherapy provide excellent disease control for patients with late isolated CNS or combined marrow and CNS relapse. Children with brief first remissions remain at substantial risk of subsequent relapse with this therapy, especially in the marrow and testes.

Adolescent↗
PubMed1999

Surviving cancer competently intervention program (SCCIP): a cognitive-behavioral and family therapy intervention for adolescent survivors of childhood cancer and their families.

Psychological reactions to having had childhood cancer often continue after treatment ends, for survivors and their parents. Based on our previous research, we developed an intervention program for adolescent survivors of childhood cancer, their parents, and siblings. Surviving Cancer Competently: An Intervention Program--SCCIP--is a one-day family group intervention that combines cognitive-behavioral and family therapy approaches. The goals of SCCIP are to reduce symptoms of distress and to improve family functioning and development. SCCIP is described and data from a pilot study of 19 families are presented. Program evaluation data indicated that all family members found SCCIP helpful. Standardized measures administered before the intervention and again at 6 months after SCCIP showed that symptoms of posttraumatic stress and anxiety decreased. Changes in family functioning were more difficult to discern. Overall, the results were promising with regard to the feasibility of the program and its potential for reducing symptoms of distress for all family members.

Adaptation, Psychological↗
PubMed1998

A framework for understanding and responding to the psychosocial needs of children with Langerhans cell histiocytosis and their families.

This article presents a five-point framework to help health-care providers understand and manage important psychosocial issues related to Langerhans cell histiocytosis (LCH). It entails frank and open discussions with patients and their families of how the disease can affect them individually and collectively. Each point is explained and then applied to two different cases. The framework is applicable to all chronic pediatric diseases, but is particularly relevant for rare conditions with unknown etiologies such as LCH.

Adult↗
PubMed1998

Neuropsychological outcome of children undergoing bone marrow transplantation.

The purpose of the study was to prospectively evaluate the neuropsychological functioning of children and adolescents receiving a bone marrow transplant (BMT). One hundred and twenty-two children with malignant or nonmalignant disorders and no previous cranial radiation therapy received a pre-BMT neuropsychological evaluation. Surviving children received a 1 year post-BMT neuropsychological evaluation. Patients were placed in a chemotherapy only (chemo) or a chemotherapy and total body irradiation (chemo + TBI) group for statistical analysis. The data were analyzed by t-tests for paired samples. There were no statistically significant differences. Regression analysis failed to identify treatment, age and gender effects. The results suggest that global and specific areas of neuropsychological functioning 1 year post-BMT were not detrimentally affected by chemotherapy or chemotherapy with total body irradiation.

Adolescent↗
PubMed1996

Triage: limitations in predicting need for emergent care and hospital admission.

STUDY OBJECTIVE: Little is known about the accuracy and reliability of current triage methods. We examined agreement among observers with regard to the need for ED care and the ability to predict at triage the need for admission to the hospital and compared these findings with admission rates after medical evaluation and management. METHODS: We used a crossover design in which each subject was subjected to nurse or computer-guided triage first, the other type of triage second, and physician triage last. Our null hypothesis: Triage methods will yield the same results. Our patients were a consecutive sample of patients at the ED of a university-affiliated county referral center. Critically ill patients were excluded. Triage categorization was examined for interobserver agreement (kappa-statistic) and prediction of admission (sensitivity, specificity, and predictive values). RESULTS: Of the 5,106 patients enrolled in the study, 289 (6.2%) were admitted. With regard to the agreement of triage categorizations, we found kappa-values of .452 and .185, respectively, for physician triage compared with nurse (SE +/- .012) and computer triage (SE +/- .012)(P = .001 for the difference between the kappa values). Sensitivity and specificity in predicting admission were 41.3 and 93.8, respectively, for nurses, 61.6 and 87.1, respectively, for physicians; and 68.2 and 73.6, respectively, for computer-aided triage. CONCLUSION: We found great variability among physicians, nurses, and a computer program with regard to triage decisions. Comparison of the three groups' triage decisions with actual data after medical evaluation and management showed that none of the three performed well in predicting which patients required admission. Until triage methods are standardized and validated, triage decisions should not be used to determine the timeliness of access to emergency care.

Adolescent↗
PubMed1991

Merging expertise and resources for research.

Nurse educators and nurse administrators share an interest in research. When a group of nursing administrators identified a need for research in their community hospital, a collaborative effort was initiated with a nurse educator from a nearby school of nursing. The successful collaborative effort proceeded through the four stages as identified by Keefe, Pepper, and Stoner (1988): Initiation, generation, incorporation, and validation. The activities and outcomes of each stage are described. The results of the collaborative effort were positive, creating advantages for all involved.

Diffusion of Innovation↗
PubMed1984

Successful treatment of paroxysmal supraventricular tachycardia with MAST.

We have noted that inflation of the military antishock trousers (MAST) successfully converted five of six patients with paroxysmal supraventricular tachycardia to normal sinus rhythm. In all patients the usual "vagal" maneuvers were tried first and were unsuccessful. MAST inflation may be a safe and useful addition to the traditional vagal maneuvers used to treat paroxysmal supraventricular tachycardia.

Adult↗