F. Ross Woolley

The effects of doctor-patient communication on satisfaction and outcome of care

Abstract From data on a series of 1761 episodes of acute primary care, the chain of relationships between patient expectation, doctor-patient communication, compliance, outcomes of care and satisfaction was examined. Overall few meaningful correlations were found. There was a strong positive relationship between patient satisfaction and functional outcome. Nonetheless, 65% of those patients who failed to regain their usual functional status professed satisfaction with the outcome of their care. Using discriminate analysis, we could predict satisfaction with outcome best by the actual outcome and satisfaction with care. Patient satisfaction with care was in turn best predicted from four variables: satisfaction with outcome, the continuity of care, patient expectation and doctor-patient communication. Implications of both positive and negative findings are discussed.

Catalytic asymmetric cyclopropanation at a chiral platform

Novel chiral Robson-type macrocyclic complexes M(2)-L [where M = Mn(II), Mn(III), Co(II) and Co(III) and L denotes tetra-Schiff base chiral ligands, L1 or L2] have been synthesized by metal template condensation of 2,6-diformyl-4-methyl-phenol, with 1R,2R-diaminocyclohexane (L1) or 1R,2R-diphenylethylenediamine (L2). The dinuclear Co(II) and Co(III) complexes catalyze asymmetric cyclopropanation of styrene with diazoacetate cooperatively and with high enantioselectivity.

Setup and characterization of a human head and neck squamous cell carcinoma xenograft model in nude rats

OBJECTIVE: To develop and characterize a new head and neck cancer animal model. STUDY DESIGN: A human head and neck squamous cell carcinoma (HNSCC) xenograft model in nude rats was established via subcutaneous inoculation of a human-origin HNSCC cell line, SCC-4. The tumor was evaluated for growth characteristics, pathologic features by hematoxylin-eosin (HE) staining, and immunohistochemistry of epidermal growth factor receptor (EGFR). 2-[18F] fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) imaging characteristics were studied too. RESULTS: A new HNSCC animal model was successfully established. Tumor sizes reached about 1 cm3 on day 15 after tumor cell inoculation. HE staining pathology has confirmed that this tumor is a typical SCC. EGFR immunohistochemistry demonstrated this tumor model to be strongly EGFR positive. 18F-FDG PET study has shown that 18F-FDG accumulated in tumors. CONCLUSIONS: This study has demonstrated that this tumor model is an appropriate HNSCC tumor model for animal studies on HNSCC.

Effectiveness of implementing a trauma triage system on outcome: a prospective evaluation.

A 9-month prospective study was conducted in Salt Lake County to evaluate the efficacy of a field trauma triage system using the CRAMS score. Before the triage system was implemented trauma victims were taken to the nearest appropriate hospital. Post-implementation, trauma victims with field CRAMS scores of 1 through 6 were triaged to the Level I Trauma Center. Of the 113 study patients, 53 were in the pre-implementation phase and 60 in the post-implementation phase. The study patients with CRAMS scores of 4 or less had lower mortality when cared for at the Level I Trauma Center (p = 0.013). We conclude that trauma patients who are severely injured (CRAMS less than or equal to 4) have a significantly higher rate of survival if taken to the Level I Trauma Center. The use of the CRAMS triage system appears to be an effective approach toward improving trauma care in Salt Lake County.

Artificial zinc(II) complexes regulate cell cycle and apoptosis-related genes in tumor cell lines

Various proteins involved in transcriptional regulation possess highly selective DNA‐binding domains, known as zinc fingers. However, little is known about small‐molecule zinc(II) complexes in the regulation of gene expression and programmed cell death. A new family of zinc(II) complexes is reported, which might be useful against human cancer cells. By using template synthesis and in vitro cell‐line screening, a set of zinc(II) complexes has been found to induce apoptosis of cancer cells and display single‐reagent in vitro cytotoxicity. The method used to synthesize the molecules resulted in “built‐in” luminescent behavior. Confocal optical imaging clearly demonstrated penetration through the cell membrane by these metal complexes. We have discovered that C3, the meso‐zinc(II) complex is an extremely efficient regulator of the cell cycle and anti‐apoptosis genes bcl‐2 and bcl‐xL. This study provides a new insight into the development of zinc(II) complexes as potential drugs.

Theoretical study of the influence of a heterogeneous activity distribution on intratumoral absorbed dose distribution.

Radioimmunotherapy of hematopoeitic cancers and micrometastases has been shown to have significant therapeutic benefit. The treatment of solid tumors with radionuclide therapy has been less successful. Previous investigations of intratumoral activity distribution and studies on intratumoral drug delivery suggest that a probable reason for the disappointing results in solid tumor treatment is nonuniform intratumoral distribution coupled with restricted intratumoral drug penetrance, thus inhibiting antineoplastic agents from reaching the tumors center. This paper describes a nonuniform intratumoral activity distribution identified by limited radiolabeled tracer diffusion from tumor surface to tumor center. This activity was simulated using techniques that allowed the absorbed dose distributions to be estimated using different intratumoral diffusion capabilities and calculated for tumors of varying diameters. The influences of these absorbed dose distributions on solid tumor radionuclide therapy are also discussed. The absorbed dose distribution was calculated using the dose point kernel method that provided for the application of a three-dimensional (3D) convolution between a dose rate kernel function and an activity distribution function. These functions were incorporated into 3D matrices with voxels measuring 0.10 x 0.10 x 0.10 mm3. At this point fast Fourier transform (FFT) and multiplication in frequency domain followed by inverse FFT (iFFT) were used to effect this phase of the dose calculation process. The absorbed dose distribution for tumors of 1, 3, 5, 10, and 15 mm in diameter were studied. Using the therapeutic radionuclides of 131I, 186Re, 188Re, and 90Y, the total average dose, center dose, and surface dose for each of the different tumor diameters were reported. The absorbed dose in the nearby normal tissue was also evaluated. When the tumor diameters exceed 15 mm, a much lower tumor center dose is delivered compared with tumors between 3 and 5 mm in diameter. Based on these findings, the use of higher beta-energy radionuclides, such as 188Re and 90Y is more effective in delivering a higher absorbed dose to the tumor center at tumor diameters around 10 mm.

Measuring outcomes of care in an ambulatory primary care population. A pilot study.

This study developed a practical method for determining the functional outcome status of patients in an ambulatory setting. Health status of 1,840 primary care patients was compared at three points in time: patients usual status, status at the initial visit, and status at time of telephone follow-up. Follow-up status was also compared with the physicians expectation, which was estimated at the time of the initial visit. Of the patients, 62% showed improvement, 31% remained at the same level, and 7% deteriorated from the time of their initial clinic visit. Physicians tended to overestimate either the speed or degree with which patients return to their usual functional status; 32% of the patients studied reported themselves as being less well than usual at the time of follow-up.This study developed a practical method for determining the functional outcome status of patients in an ambulatory setting. Health status of 1,840 primary care patients was compared at three points in time: patients usual status, status at the initial visit, and status at time of telephone follow-up. Follow-up status was also compared with the physicians expectation, which was estimated at the time of the initial visit. Of the patients, 62% showed improvement, 31% remained at the same level, and 7% deteriorated from the time of their initial clinic visit. Physicians tended to overestimate either the speed or degree with which patients return to their usual functional status; 32% of the patients studied reported themselves as being less well than usual at the time of follow-up.

Computer assisted instruction for teaching clinical decision-making

Abstract A computer-assisted instructional program was devised to teach problem-solving behavior associated with history taking. The program focuses on the problem of identifying the information value of patient history questions. A total of 68 freshmen and sophomore medical students used the computer program in conjunction with their course on physical diagnosis. Each simulated case requires the student to make a series of tentative diagnoses which are compared against the most likely diagnosis as determined by the computer. The system operates in two modes, one with feedback for instruction, and a non-feedback method for testing.

Relationship between process and outcome in ambulatory care.

The outcomes of a series of some 410 acute episodes from two family practice centers were rated on the degree to which the patient regained his usual functional status and his satisfaction with the outcome and the process of care. A portion of outcomes (251) were then compared to process scores obtained using explicit criteria and the rest to implicit process ratings based on the problem-oriented record. In both instances those cases with good outcomes had better process scores than those with bad outcomes; neither measure of satisfaction had a consistent relationship with either process measure.

Improving patients records through problem orientation

The components of Weeds problem-oriented record are described. Although particular attention is given to the use of this system in behaviorally oriented psychiatric institutions, the basic principles have general application to other settings and treatment approaches.