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Biomedical subjects

J W Robinson

Publications and source records attributed to J W Robinson.

At least 19 recordsLinked to original sources
PubMed2002

Prospective trial of cryosurgical ablation of the prostate: five-year results.

OBJECTIVES: To determine in a prospective pilot study the safety and efficacy of cryosurgical ablation for localized prostate carcinoma. METHODS: A total of 87 cryosurgical procedures were performed on 76 consecutive patients between December 1994 and February 1998. All patients had histologically proved adenocarcinoma of the prostate, with prostate-specific antigen (PSA) readings of less than 30 ng/mL. Clinical evaluations, PSA determinations, and patient self-reported quality-of-life questionnaires (functional assessment of cancer treatment-prostate; FACT-P) were used to determine biochemical and clinical disease-free status and complications. Patients had a mean follow-up of 50 months (minimum 36). RESULTS: Follow-up biopsies were performed in 73 patients, and 72 were negative for malignancy after one or more treatments. Ten patients required two treatments and 1 patient required three treatments. The 5-year overall and cancer-specific survival rate was 89% (95% confidence interval, 83% to 97%) and 98.6% (95% confidence interval, 96% to 100%), respectively. The undetectable PSA rate (less than 0.3 ng/mL) for low-risk patients (n = 13) was 60% at 5 years; for moderate-risk patients (n = 23), it was 77%, and for high-risk patients (n = 40), 48%. The corresponding percentage of patients with a PSA level less than 1.0 ng/mL at 5 years was 75%, 89%, and 76%. Sloughing occurred in 3 patients (3.9%), incontinence in 1 (1.3%), and testicular abscess in 1 (1.3%). At 3 years, 18 (47%) of 38 patients capable of unassisted intercourse at the time of cryosurgery had resumed sexual intercourse, 5 spontaneously and 13 with sildenafil or prostaglandin. CONCLUSIONS: The results of this prospective evaluation show cryosurgery to be both a safe and an effective option in the treatment of localized prostate cancer.

Adenocarcinoma↗
PubMed2001

Quality of life in ovarian cancer patients receiving chemotherapy.

OBJECTIVE: A descriptive study was performed to evaluate the variables which influence the quality of life of women with ovarian cancer undergoing chemotherapy treatment. METHODS: The study involved a chart review of 60 women with ovarian cancer and analysis of their compiled EORTC QLQ-C30 Quality of Life (QoL) questionnaires. Analyses were performed using SPSS software to test the relationship of a number of biomedical variables with QoL outcomes. RESULTS: In comparing QoL scores between newly diagnosed women receiving first-line (cisplatin) chemotherapy and women receiving palliative (carboplatin) therapy for recurrent disease, those receiving first-line therapy had more appetite disturbance, diarrhea, and nausea than women in the latter group. Over time, global QoL declined for newly diagnosed patients, while it improved for those with recurrent disease. A third finding was that younger women reported more fatigue over the course of their treatment than older women. Finally, lower QoL was found to be able to predict death within 12 months after starting treatment. CONCLUSIONS: The EORTC QLQ-C30 can be used to test clinical assumptions and to influence treatment programs of women with ovarian cancer undergoing chemotherapy. The results confirmed the assumption that carboplatin has less of an impact on QoL than cisplatin. Also, the finding of improvements in QoL over time, for the women with recurrent disease, supports the use of carboplatin as palliative treatment. The differences observed in QoL between survivors and nonsurvivors 12 months after starting treatment may help identify high-risk patients for closer monitoring. Brief, structured QoL assessments before clinic appointments may be useful for improving the overall care of ovarian cancer patients.

Adult↗
PubMed2001

Costs of managing Helicobacter pylori-infected ulcer patients after initial therapy.

BACKGROUND: The objective of this research was to evaluate the outcomes and costs of alternative approaches to managing patients previously treated for peptic ulcer disease and Helicobacter pylori infection. MATERIALS AND METHODS: A decision-analytic model was used to compare (1a) urease breath testing (UBT) for assessment of H. pylori status versus (1b) observation without further testing or treatment, among patients who were symptom-free following initial antimicrobial and antisecretory therapy for endoscopically demonstrated ulcer and H. pylori infection; and (2a) UBT versus (2b) repeat endoscopy with H. pylori testing, and versus (2c) repeat antimicrobial and antisecretory therapy without further testing, among patients who remained symptomatic following initial therapy. RESULTS: Among patients who were symptom free after initial therapy, 6.1% receiving UBT had symptomatic ulcer at one year, compared to 18.2% of those simply observed. The expected first-year cost per symptom-free patient following initial therapy was $591 for UBT compared to $480 for observation. Among patients with persistent symptoms after initial therapy, 21% receiving repeat therapy had symptomatic ulcer at one year, compared to 23.8% receiving repeat endoscopy, and 23.3% receiving UBT. Corresponding medical costs per patient were, respectively, $766, $1787 and $1122. CONCLUSIONS: The optimal approach to managing patients following initial treatment for ulcer and H. pylori infection depends on symptom status following initial therapy. For symptomatic patients, the preferred approach is to prescribe a repeat course of antimicrobial and antisecretory therapy. For patients without symptoms following initial therapy, UBT is the preferred approach because it is associated with a threefold lower risk of symptomatic ulcer at one year, although it costs an additional $110 per patient, compared with observation.

Breath Tests↗
PubMed2000

General measures for signal-noise separation in nonlinear dynamical systems.

We propose the straight phi divergences from statistics and information theory (IT) as a set of separation indices between signal and noise in stochastic nonlinear dynamical systems (SNDS). The straight phi divergences provide a more informative alternative to the signal-to-noise ratio (SNR) and have the advantage of being applicable to virtually any kind of stochastic system. Moreover, straight phi divergences are intimately connected to various fundamental limits in IT. Using the properties of straight phi divergences, we show that the classical stochastic resonance (SR) curve can be interpreted as the performance of a nonoptimal, or mismatched, detector applied to the output of a SNDS. Indeed, for a prototype double-well system with forcing in the form of white Gaussian noise plus a possible embedded signal, the whole information loss can be attributed to this mismatch; an optimal detection procedure (for the signal) gives the same performance when based on the output as when based on the input of the system. More generally, it follows that, when characterizing signal-noise separation (or system performance) of SNDS in terms of criteria that do not correspond to IT limits, the choice of criterion can be crucial. The indicated figure of merit will then not be universal and will be relevant only to some family of applications, such as the classical (narrow-band SNR) SR criterion, which is relevant for narrow-band post processing. We illustrate the theory using simple SNDS excited by both wide- and narrow-band signals; however, we stress that the results are applicable to a much larger class of signals and systems.

Journal Article↗
PubMed2000

Capillary electrochromatography of cholesterol and its ester derivatives.

Separation of cholesterol and its ester derivatives using micellar electrokinetic chromatography is a challenge due to the extreme hydrophobicity of these compounds. In this work, an isocratic capillary electrochromatography (CEC) method has been developed to separate a complex mixture of cholesterol and its 12-ester derivatives. The proportions of mobile phase (tetrahydrofuran, acetonitrile, water), as well as the effects of acid modifiers, buffer concentrations, voltage, and temperature on the separation of cholesterol derivatives were investigated. Addition of a polymeric surfactant, poly(sodium N-undecanoyl-L-glycinate), to the mobile phase reduced migration time and improved resolution of the analytes. The CEC method developed allows baseline separation of a complex mixture of cholesterol and 12 ester derivatives in less than 40 min. Finally, the method is applied to the characterization of cholesterol, cholesterol linoleate, and cholesterol oleate extracted from atherosclerotic plaque deposits in the arterial walls of a human aorta.

Aged↗
PubMed1999

Quality-of-life outcomes for men treated with cryosurgery for localized prostate carcinoma.

BACKGROUND: Cryosurgery was introduced as an alternative to radiotherapy or radical prostatectomy in the mid-1960s. Although it met the primary objective of achieving local control, it was largely abandoned due to a high incidence of complications. Technologic advances in the areas of imaging and urethral warming have renewed interest in this treatment methodology. The aim of the current study was to determine the quality of life of men enrolled in a Phase II clinical trial of cryosurgery for the treatment of localized prostate carcinoma. METHODS: Men were administered the Functional Assessment of Cancer Treatment-Prostate (FACT-P) prior to their treatment and at 6 weeks and 3, 6, and 12 months posttreatment. RESULTS: By 12 months after cryosurgery, most of the FACT-P subscales had returned to pretreatment levels, following a decline in well-being immediately after cryosurgery. There were two exceptions to this general trend: At 12 months, impairments in social/family well-being and sexual function still remained. The average time to return to work after therapy was 3 weeks. Stay in hospital after treatment was limited to 1 day for 94% of the participants. Compared with men who received the standard treatments of radical prostatectomy and radical radiotherapy, men treated with cryosurgery appeared to have a similar quality of life, with perhaps the exception of decreased sexual function. CONCLUSIONS: The quality-of-life outcomes of this study support the current renewed interest in cryosurgery. The severe impairments reported in other studies were not seen in this sample. In fact, it appeared that all aspects of the participants' well-being had returned to pretreatment levels by 12 months, with the exception of sexual function.

Aged↗
PubMed1999

Psychoeducational group increases vaginal dilation for younger women and reduces sexual fears for women of all ages with gynecological carcinoma treated with radiotherapy.

PURPOSE: The association between radiotherapy for gynecological carcinoma and sexual dysfunction is well established. Regular vaginal dilation is widely recommended to these women as a way for them to maintain vaginal health and good sexual functioning. However, the compliance rate with this recommendation is low. The purpose of this study was to test the effectiveness of a group psychoeducational program based on the "information-motivation-behavioral skills" model of behavior change in increasing the rate of compliance. METHODS AND MATERIALS: Thirty-two women with Stage I or II cervical or endometrial carcinoma who were being treated with radiotherapy were randomized and received either the experimental group program or the control intervention that consisted of written information and brief counseling. Outcome measures included global sexual health, knowledge about sexuality and cancer, fears about sexuality after cancer, and vaginal dilation compliance. RESULTS: Younger women attending the experimental program (44.4%) were significantly more likely to follow recommendations for vaginal dilation than those who received the control intervention (5.6%). Women, regardless of age, who received the experimental intervention reported less fear about sex after cancer treatment. The older women who received the experimental intervention gained more sexual knowledge. There was no evidence that the experimental intervention improved global sexual health. CONCLUSIONS: This is the first controlled study to provide evidence of an intervention's effectiveness 1. in increasing women's vaginal dilation following radiotherapy for gynecological carcinoma and 2. in reducing their fears about sex after cancer. Most women, particularly younger women, are unlikely to follow the recommendation to dilate unless they are given assistance in overcoming their fears and taught behavioral skills.

Adult↗
PubMed1999

Psychosocial problem disclosure by primary care patients.

The vast majority of psychologically distressed primary care patients present exclusively somatic concerns at the outsets of their visits. However, it is not known how often such patients subsequently disclose psychosocial problems to their primary care physicians (PCPs) and what variables predict such disclosures. Our objectives were to measure, among psychologically distressed primary care patients, the frequency of disclosure of psychosocial problems (disclosure), the effects of prior psychosocial inquiry (prior inquiry) by PCPs and various patient variables on disclosure, and the effect of disclosure on mental health problem recognition (recognition) by PCPs. The study was based in the practices of 69 community-based PCPs and involved 308 adult patients with 28-item General Health Questionnaire scores of 5 or greater, indicating significant psychological distress. Disclosure occurred during 51% of visits overall and 67% of visits with prior inquiry. The odds of disclosure were increased by prior inquiry (p < 0.001), greater physician-patient familiarity (p < 0.001) and greater severity of patient psychological distress (p < 0.001). Prior inquiry and physician-patient familiarity had a negative interaction (p < 0.05) of smaller size than either variable's main effect, so that their combined effect on disclosure exceeded the effect of either variable alone but was less than multiplicative. The estimated odds ratio for recognition given disclosure was 24.13 (95% confidence interval, 11.28-51.63) after adjustment for the effects of significant covariates. We conclude that if PCPs inquire, most psychologically distressed, somatically presenting patients will disclose psychosocial problems. Inquiry is particularly productive with unfamiliar patients. PCPs can engender a substantial increase in psychosocial disclosure simply by adding one or two questions about mood or interpersonal problems to their clinical interviews.

Adolescent↗
PubMed1999

Counseling by primary care physicians of patients who disclose psychosocial problems.

BACKGROUND: Most descriptive studies of psychosocial counseling by US primary care physicians (PCPs) have relied on the PCPs' recollections rather than researchers' observations of actual visit content. The latter approach should yield more accurate measurement of counseling frequency and duration. METHODS: Our sample consisted of 308 patients whose scores signified psychological distress on the 28-item General Health Questionnaire. Their visits to 69 community-based PCPs had been audiotaped for an earlier study of the benefits of communication skills training for PCPs. Using those tapes, we identified the disclosure of psychosocial problems by patients and subsequent counseling and psychotropic drug prescribing by their PCPs. We timed counseling and visit lengths. Effects of patient and PCP variables on visit duration and on counseling occurrence and duration were assessed using generalized estimating equations to accommodate the correlation among patients who shared PCPs. RESULTS: After adjusting for the effects of the communication skills training, we found that PCPs counseled 60% of patients who disclosed psychosocial problems. Given disclosure, counseling probability was lowest for new patients (P <.001); among patients with previous visits, counseling probability was inversely related to the number of visits (P <.001). When provided, counseling had a mean duration of 5.2 minutes. Counseling was associated with a 28% (95% confidence interval, 9%-49%) increase in visit duration after adjustment for the effects of other significant variables. PCPs prescribed psychotropic medications in 30% of visits with disclosure. CONCLUSIONS: PCPs treated psychosocial problems with brief counseling twice as often as with medication. Brief counseling interventions caused small but significant increases in visit durations.

Adolescent↗
PubMed1998

Hypersensitivity reaction to azathioprine.

Adverse drug reactions can vary from a simple rash to anaphylactic shock. While certain medications including the penicillins are well known to cause such reactions, other drugs are not as commonly recognized. Azathioprine hypersensitivity reactions tend to be benign and self-limiting with cessation of drug ingestion. We report a patient who had a hypersensitivity reaction to azathioprine, which manifested as distributive shock that mimicked sepsis. We also reviewed the English language literature for risk factors for a hypersensitivity reaction to azathioprine and its possible mechanism.

Acute Kidney Injury↗
PubMed1997

Erectile functioning of men treated for prostate carcinoma.

BACKGROUND: Published reports of complication rates, such as erectile dysfunction, associated with treatments for prostate carcinoma are often used to guide patient decision-making and develop clinical guidelines. Unfortunately, the published data are largely comprised of case series from single institutions. Meta-analysis is a methodology for combining findings from several studies to produce a better result. METHODS: A comprehensive literature review and subsequent meta-analysis of the rates of erectile dysfunction associated with external beam radiotherapy and radical prostatectomy was conducted. A simple logistic regression model was used to combine the data from 40 articles that met selection criteria. RESULTS: The probability of maintaining erectile functioning after radiotherapy is 0.69. The probability after surgery is 0.42. This difference is significant. Analysis of the effects of variables such as patient age and stage of disease on erectile functioning could not be performed due to inconsistencies across studies and the limited number of studies reporting such variables. CONCLUSIONS: The published data indicate that men with normal erectile functioning are more likely to retain this function after radiotherapy than after surgery. Attention is drawn to the weaknesses in the reviewed studies in the hope that the clinical trials of emerging treatments, such as cryotherapy, brachytherapy, three-dimensional conformal radiotherapy, and neoadjuvant hormones can be strengthened to reflect more accurately the rate of treatment-associated erectile dysfunction.

Databases, Factual↗
PubMed1997

Family and employment status associated with women's criminal behavior.

Exploring the relationship between women's criminal behavior as evidenced in violence, type of crime, prior criminal history, and the fulfillment of traditional female roles delineated by marital status, employment status, or presence of children in the home of the woman was based on the evaluation of 141 female inmates, which indicated a limited relationship between fulfilling traditional female roles and the nature of female criminal activity. Married and previously married subjects tended to be involved primarily with murder and secondarily with theft. Single subjects were involved primarily with theft and secondarily involved with robbery. Employed subjects were more likely to be involved with theft and nonviolent crime. Unemployed subjects were more likely to be involved in violent crimes.

Adolescent↗
PubMed1996

Comparison of prevalence of anti-hepatitis C virus antibodies in differing South American populations.

Very little is known about the distribution of hepatitis C virus (HCV) within South America. To assess the exposure of the general population to this virus, a number of sera obtained from three distinct geographical and racial groups were screened using a combination of immunoassays. Initial screening was undertaken with an inhouse immunoassay (core-ELISA) using synthetic peptides based on the N-terminus of the HCV core protein. Sera which were repeatedly positive by core-ELISA were also assessed using a commercial third-generation assay. The highest prevalence rate (2.3%) was seen in sera taken from the Tumaco region of Colombia. Lower rates were found in sera taken from La T, Ecuador (0.7%) and Las Majadas, Venezuela (0.7%). This indicates significantly different prevalence in different racial and geographical groups within the region.

Amino Acid Sequence↗
PubMed1996

Undetectable IgE responses after respiratory syncytial virus infection.

Sequential nasopharyngeal secretions were collected from 81 infants from one day to three months after admission to hospital with respiratory syncytial virus (RSV) infection. Samples from 21 infants were assayed for anti-RSV IgE in an antigen capture ELISA assay. No IgE antibodies were detected although an assay of IgA antibodies carried out in parallel by a similar technique detected IgA antibodies in the secretions of all patients tested. Neither prior absorption of IgA or IgG, concentration of the secretions by freeze drying, nor enzyme amplification of the assay revealed any virus specific IgE. Using an antibody capture ELISA with a sensitivity of 0.85 IU/ml, IgE could be detected in sequential secretions of only one of the 81 RSV infected infants studied. Further testing of the secretions from 12 of these patients and those of a further 15 using an enzyme amplified assay with a sensitivity of 0.1 IU/ml revealed no further positives. Low concentrations of IgE were found in the sera of the majority of infants with RSV infection but they did not differ from those of virus negative children of a similar age collected between RSV epidemics. No rise in mean serum IgE concentrations between acute and convalescent samples was observed. No virus specific IgE was detected in the sera of any infant using the enzyme amplified antigen capture ELISA.

Antibodies, Viral↗
PubMed1996

Control of Aedes albopictus in waste tire piles with reduced rates of temephos-treated granules.

Two days following treatment, larval populations of Aedes albopictus in waste tires treated with granular formulations of temephos were reduced 90% at the 0.11 kg AI/ha rate, 98% at the 0.56 kg AI/ha rate, and 100% at the 1.12, 11.21, and 22.42 kg AI/ha rates. Nearly 100% control was achieved for 8 wk at the 0.5 kg AI/ha rate, for 7 wk at the 1.12 kg AI/ha rate in one replicate, and for at least 5 months at the 11.21 and 22.42 kg AI/ha rates. These results indicate that prolonged control can be achieved with granular formulations at half (11.21 kg/ha) the maximum label rate and that excellent immediate control can be expected at 2.5% the maximum label rate.

Aedes↗