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Biomedical subjects

P Leichner

Publications and source records attributed to P Leichner.

At least 19 recordsLinked to original sources
PubMed2001

Information as a distinct dimension for satisfaction assessment of outpatient psychiatric services.

The purpose of this study is to verify whether information on services would appear as a distinct dimension of satisfaction in a multidimensional scale. Data collection was performed in two phases: 263 patients received the original version of the questionnaire and 200 received an adapted version of the scale. The findings suggest that not only is it important to consider information as a distinct dimension of satisfaction but it is equally important to examine three categories, consisting of satisfaction with information on; patients' problems/illness; distinct treatment components such as medication and psychotherapy; and patients' treatment progress.

Adolescent↗
PubMed2000

Phase I/II trial of multiple dose 131Iodine-MAb LL2 (CD22) in patients with recurrent non-Hodgkin's lymphoma.

The purpose of this to evaluate in a phase I/II study the efficacy and toxicity of a multi-dose administration of 131I labeled CD22 monoclonal antibody (131I-MAb-LL2) in escalating dose cohorts administered to relapsed non-Hodgkin's lymphoma (NHL) patients. Twenty-one patients with relapsed NHL received one of four dose levels of 131-MAb-LL2 administered in a twice weekly pattern. Starting with dose level 2, the patients also received 20 mg of unlabeled LL2 prior to each radiolabeled dose administered. Previously stored autologous peripheral blood progenitors were reinfused in case of prolonged cytopenias. Patients could repeat the same treatment if they had stable disease or a response to the first therapy at 8 weeks, and had not received their peripheral blood progenitors with the first cycle. Combining all of the dose cohorts, there were 5 complete responses or complete responses (undetermined) and 2 partial responses for a total response rate of 7/21 (33%). There was no dose response effect with responses documented at all dose levels. Expected toxicities were hematopoietic, requiring stem cell re-infusion in 5 patients. Other toxicities included hypothyroidism in 3 patients, and human anti-mouse antibody formation (HAMA) in 4 patients. In conclusion, 131I-MAb-LL2, when administered in a multi-dose fashion with 20 mg unlabeled antibody pre-dosing, resulted in a response rate of 33% in heavily pre-treated NHL patients. Non-hematologic toxicities were mild and few in number. Further evaluation of this treatment is warranted and further dose escalation will be possible.

Adolescent↗
PubMed2000

High-dose therapy with 90Yttrium-labeled monoclonal antibody CC49: a phase I trial.

A Phase I trial of increasing administered activities of 90yttrium (90Y)-labeled monoclonal antibody (MAb) CC49 was conducted to determine whether extrahematopoietic toxicity occurred with this radioimmunoconjugate. Twelve patients with various gastrointestinal tract cancers were administered a tracer dose of 111In-labeled MAb CC49 for biodistribution and pharmacokinetic studies. Patients then underwent a single treatment with increasing administered activities of 90Y-labeled MAb CC49 (0.3, 0.4, and 0.5 mCi/kg). Biodistribution studies, using 111In-labeled MAb CC49 as a surrogate, were determined using planar and single photon emission computed tomography imaging. Pharmacokinetic studies were performed by measuring radioactivity in blood samples taken at intervals after radioimmunoconjugate infusions. Tissue biopsies of tumor metastases and related normal tissues (liver and bone marrow) were obtained for radioactivity measurements. Radiation dosimetry estimates were calculated using these data. Toxicity was evaluated using the National Cancer Institute Common Toxicity Criteria. No dose limiting extrahematopoietic toxicity was identified in the range of administered activities used in this study. Radioimmunolocalization based on planar and single photon emission computed tomography images 111In-labeled MAb CC49 showed heterogeneous (nonspecific) liver and splenic uptake. Liver metastases were usually photopenic, and extrahepatic metastases showed faint to moderate uptake. The alpha and beta half-lives of 111In-labeled MAb CC49 and 90Y-labeled MAb CC49 in the blood were similar. Absorbed radiation dose estimates in metastatic tumor sites ranged from 180 to 3000 cGy. The percentage of injected dose/kg of tumor ranged from 1.12 to 18.14; however, tumor:normal liver ratios were consistently <1. No objective responses were observed. Doses of up to 0.5 mCi/kg could be administered with reversible grade IV myelotoxicity. Absorbed radiation dose in tumor was suboptimal, even at the highest administered activity level. Deposition of 90Y in liver was high, and estimates of absorbed dose in liver equaled or exceeded that which could be achieved in metastatic tumor sites. Strategies to enhance access of radioimmunoconjugates in tumor and diminish deposition in the liver need to be developed for effective treatment using MAb CC49 with chelated radiometals.

Adenocarcinoma↗
PubMed1999

Family climates: family factors specific to disturbed eating and bulimia nervosa.

More than a decade of research has characterized the families of individuals with bulimia and bulimia anorexia (Anorexia Nervosa, Binge/Purging Type) as less expressive, less cohesive, and experiencing more conflicts than normal control families. This two-part study investigated variables believed more directly related to disturbed eating and bulimia as contributing to a "family climate for eating disorders." In Study 1. a nonclinical sample of 324 women who had just left home for college and a sample of 121 mothers evaluated their families. Principal-components analyses revealed the same factor structure for both students and mothers, with Family Body Satisfaction, Family Social Appearance Orientation, and Family Achievement Emphasis loading together, representing the hypothesized family climate for eating disorders: the remaining variables loaded with the more traditional family process variables (conflict, cohesion, expressiveness), representing a more general family dysfunction. As predicted, the family climate for eating disorders factor score was a more powerful predictor of disturbed eating. Study 2 extended these findings into a clin ical population, examining whether the family climate for eating disorders variables would distinguish individuals with bulimia from both depressed and healthy controls. Groups of eating-disordered patients (n = 40) and depressed (n = 17) and healthy (n = 27) controls completed family measures. The eating-disordered group scored significantly higher on family climate variables than control groups. Family process variables distinguished clinical groups (depressed and eating disordered) from healthy controls, but not from one another. Controlling for depression removed group differences on family process variables, but family climate variables continued to distinguish the eating-disordered group from both control groups. Indications for further research are discussed.

Adolescent↗
PubMed1999

Psychiatric residents' views on their training and experience regarding issues related to child abuse.

OBJECTIVE: To explore the views of psychiatric residents regarding the prevalence and impact of child physical, sexual, and emotional abuse; the adequacy of their training in these areas; and the sufficiency of treatment resources for abused children and their abusers. METHOD: A 97-item survey questionnaire was distributed to 189 psychiatric residents as a section of the 1997 Coordinators of Postgraduate Education (COPE) self-assessment examination. RESULTS: Estimations of prevalence of child sexual, physical, and emotional abuse among men and women in both general and psychiatric populations were generally accurate according to the literature. Residents appeared to be aware of the multifactorial nature of child abuse and identified the particular importance of social-environmental factors such as parental drug abuse and a violent social environment. Residents also recognized the significant association of posttraumatic stress disorder, borderline personality disorder, and dissociative disorders with child sexual abuse. Seventy-five percent of respondents felt that instruction on the topic of child abuse during their psychiatric residency was insufficient. Sixty-four percent of respondents felt that resources for the treatment of effects of child abuse were insufficient; 83% felt that treatment resources for child abusers were insufficient. CONCLUSION: Although psychiatric residents appear to be aware of the prevalence of child abuse and its varied effects on the victims' mental health, the majority felt that their medical training in this area had been insufficient. For this reason, medical school curricula and training experiences might require reevaluation. Increasing the profile of child abuse and its impact on mental health might also result in enhanced prevention programs and treatment resources available to abused children and their abusers.

Adult↗
PubMed1997

Antiidiotypic response against murine monoclonal antibodies reactive with tumor-associated antigen TAG-72.

The immune response of 42 gastrointestinal and ovarian cancer patients at 1 month after exposure to murine monoclonal antibodies (B72.3 and CC49) reactive with the tumor-associated antigen TAG-72 was studied. The incidence of human anti-mouse antibody response was 89% to B72.3 and 70% to CC49. To evaluate the antiidiotypic immune response, we developed a serological assay based on affinity chromatography to remove the interference due to the presence of TAG-72, antiisotypic, and antiallotypic immunoglobulins in the serum. Seventy-eight percent of patients who received B72.3 developed an antiidiotypic response; in 33% of the patients, this was the only immune response detected. The antiidiotypic immune response after treatment with CC49 was present in 54% of the patients. Twelve percent of the patients who received CC49 developed an antiidiotypic response in the absence of antiisotypic or antiallotypic immune response. The lower immunogenicity of the variable region of CC49 is encouraging when considering the use of chimeric or humanized antibodies derived from the murine monoclonal antibody CC49 in clinical studies.

Animals↗
PubMed1997

High-dose therapy with iodine-131-labeled monoclonal antibody CC49 in patients with gastrointestinal cancers: a phase I trial.

PURPOSE: A phase I trial that evaluated for extrahematopoietic toxicity was conducted with iodine-131 (131I) labeled monoclonal antibody (MAb) CC49. Correlative studies included pharmacokinetic and biodistribution analyses, estimates of absorbed radiation dose, and measurement of human antimonoclonal antibodies (HAMA). PATIENTS AND METHODS: After collection and cryopreservation of hematopoietic stem cells, 15 patients with gastrointestinal cancers were administered a tracer dose of 131I-MAb CC49. Within 5 to 6 days, 14 patients (two to three per activity level) underwent a single treatment with 131I-MAb CC49 (50, 100, 150, 200, 250, and 300 mCi/m2). Biodistribution was determined using planar and single photon emission computer tomographic (SPECT) imaging. Pharmacokinetic studies were performed by measuring radioactivity in serial blood samples. In some patients, biopsies of metastases and related normal tissues were obtained for radioactivity measurements. Radiation dosimetry estimates were calculated using available biodistribution, pharmacokinetic, and tissue biopsy data. Toxicity was evaluated using the National Cancer Institute (NCI) Common Toxicity Criteria. RESULTS: No dose-limiting extrahematopoietic toxicity was identified. Twelve patients experienced grade IV myelosuppression and met criteria for infusion of hematopoietic stem cells. Radioimmunolocalization was excellent. The T1/2 for 131I-MAb CC49 after diagnostic and therapeutic administration was 39.7 +/- 10.4 and 46.1 +/- 10.6 hours, respectively. The percent injected dose per killigram of tumor ranged from 0.2 to 2.1. Absorbed radiation dose in metastatic tumor sites ranged from 630 to 3300 cGy. CONCLUSION: Although extrahematopoietic dose-limiting toxicity was neither observed or predicted, suboptimal absorbed dose estimates suggested that further escalation of 131I-MAb CC49 would not be useful. Future studies should focus on the use of radionuclides with high energy beta emissions, such as yttrium 90, and on strategies to optimize access of antibody to target antigens.

Adenocarcinoma↗
PubMed1997

[The future of psychiatric hospitals in Ontario].

The purpose of this paper is to review past and present roles and to speculate on the future of the Ontario provincial psychiatric hospitals (PPHs). Currently, and for the very immediate future only, there are 10 PPHs that are owned and operated by the Ministry of Health of Ontario, each serving a specified population ranging from 250,000 to over 3,000,000. In addition to clinical expertise, provincial psychiatric hospitals contribute greatly to teaching and research. Ontario's mental health reform movement has called for a shift of resources to the community and a downsizing of PPHs by 2003. In response to fiscal pressures, in 1996 provincial legislation was passed to establish the Health Services Restructuring Commission (HSRC) as a stand-alone corporation with powers to restructure and reengineer health services in Ontario. The HSRC has to date recommended the closure of 4 PPHs by 1999 and the integration of theses services into other medical facilities. While a rebalancing of the mental health system does need to take place, the fiscally driven haste to close hospitals has created a crisis atmosphere in PPHs for staff and patients. It is also unlikely that the necessary community resources will be in place to buffer these changes. The new restructuring plans not only set unrealistic timelines, they seem to underestimate the importance PPHs have played in teaching, research and the advancement of clinical treatment and rehabilitation of the severely mentally ill. It may be that, in the long run, service integration and divestment/closure of the PPHs will result in better access to services closer to smaller communities and in the destigmatization of the mentally ill, however, without close evaluative monitoring and appropriate leadership, it could also lead to decreased research, training and quality of care.

Community Mental Health Services↗
PubMed1996

Patients' requests and satisfaction with services in an outpatient psychiatric setting.

OBJECTIVE: Patients in four major diagnostic categories were compared to determine if their satisfaction with outpatient services varied. Both overall satisfaction and the degree to which clients and therapists agreed on the importance of 16 aspects of treatment were examined. METHODS: The Patient Request Form (PRF) and the Client Satisfaction Questionnaire were used to interview 464 outpatients. The professional who was the primary contact for each patient filled out a therapist version of the PRF. Diagnoses were grouped into four major categories: anxiety disorders, affective disorders, schizophrenia, and other psychotic disorders. RESULTS: The diagnostic groups differed in overall satisfaction with treatment, treatment characteristics, patients' reasons for coming to the clinic, therapists' descriptions of treatment, and patient-therapist agreement on the importance of different aspects of treatment. Agreement between patients and providers was associated with higher levels of patients' satisfaction. Patients with schizophrenia or with other psychotic disorders had the lowest level of agreement with their therapists and also were the least satisfied. In all patient categories, therapists underestimated the importance to patients of having a reliable source of help. CONCLUSIONS: The greater dissatisfaction expressed by patients with schizophrenia and other psychotic disorders may be related to their therapists' undervaluing the nonbiological aspects of treatment such as social support. Combining medication with psychosocial approaches that have been adapted for patients with psychotic disorders is likely to improve the patients' satisfaction and compliance and increase the overall effectiveness of treatment.

Adult↗
PubMed1995

Residents' perceptions of transcultural psychiatric practice.

A questionnaire was distributed to 190 psychiatry residents to analyze the impact of three factors on residents' perceptions of their transcultural practice: cultural identity of residents; degree of exposure to patients from different cultures; and training in cultural psychiatry. Results suggest that residents' perceptions vary according to the resident's cultural origin. The training in psychiatry and the degree of exposure to patients from different cultures had no significant influence on the residents' perceptions. Overall these results emphasize the necessity to revise the cultural content of residents' psychiatry curriculum to, among other things, raise residents' awareness of their own cultural identity.

Adult↗
PubMed1994

[Validation of an eating attitude scale in a French-speaking Quebec population].

The Eating Attitudes Test (EAT-26) is one of the most frequently used screening questionnaires for anorexia and bulimia nervosa for use with clinical and general populations. Although the psychometric qualities of the instrument have been reported for the English version, little has been done to date to validate a French version. A french version of the EAT-26 was distributed to anglophone students and francophone students, as well as anglophone and francophone patients. Overall, the results demonstrated that the authors' French version has the same psychometric characteristics as the English version when used with clinical and non clinical populations. The overall test and its subscales differentiated between patients and non patients similarly in both linguistic groups. The internal consistency of the two versions, as assessed by Cronbach's alpha, was comparable. Among female high-school students, 14.1% of the anglophone students and 14.3% of the francophone students scored above the cutoff score for significant eating disorders behaviour.

Adolescent↗
PubMed1992

[Psychometric characteristics of the French Canadian version of a satisfaction scale for hospitalized psychiatric patients].

This paper presents the results of a content and convergent validity study of the French-Canadian version of a standardized satisfaction scale for hospitalized psychiatric patients. One hundred and twenty-two patients underwent an interview during which they completed the translated version of the Client Satisfaction Questionnaire, developed by Distephano et al, and answered open-ended questions on their satisfaction with the services they received. The results revealed strong correlations between these measures of satisfaction and a high level of internal consistency for the Distefano scale, suggesting satisfactory psychometric characteristics for this French version. As for the original questionnaire, the factorial structure yielded at least two distinct satisfaction dimensions. These results, and those of the content analysis, based on answers from the open-ended questions, helped to identify aspects mentioned by the patients but not covered by the items included in the satisfaction scales. The units' cleanliness, therapists' work and attitudes and privacy on the units are examples of these dimensions.

Adult↗
PubMed1991

A randomized prospective trial comparing full dose chemotherapy to 131I antiferritin: an RTOG study.

A previously reported Phase I/II multimodality program for non-resectable hepatocellular cancer began with external beam-radiation and chemotherapy, followed by administration of 131I antiferritin-specific radioimmunoglobulin and led to a 48% remission (7% complete remission and 41% partial remission). Survival and response depended on alpha fetoprotein status. AFP+ patients had a median survival of 5 months; AFP- patients had a median survival of 10.5 months. No acute effects occurred relative to treatment with radiolabeled antibody. A randomized prospective study was designed to compare full dose chemotherapy consisting of 60 mg/m2, doxorubicin and 500 mg/m2 of 5-fluorouracil administered every 3 weeks, to 131I antiferritin administration every 8 weeks and allowed for crossover treatment if tumor progression occurred. Overall, radiolabeled antibody administration and full dose chemotherapy led to equivalent partial remission rates (22-30% vs 23-25%) and survival rates compared to chemotherapy (6 month median; AFP+ 5 months; AFP- 10 months). The most important new observations were the response in AFP- patients who, following chemotherapy failure, achieved remission using 131I radiolabeled antibody (7/11) and a subset of patients (7%) who were treated with radiolabeled antibody and converted from non-resectable to resectable status followed by surgical excision.

Adult↗
PubMed1991

Severe paternal sexual abuse in early childhood and systematic aggression against the family and the institution.

This report examines incest and its sequela in individuals suffering from severe chronic mental illness. Descriptive data drawn from 11 cases paints a clinical picture characterized by severe chronic psychotic symptoms and aggressive behaviour that are often precipitated by the family's rejection. In all patients, the incest for occurred over a long period of time, was violent, and was perpetrated by the male parental figure. Health care professionals need to increase their knowledge of and skills in the identification and treatment of sexual abuse.

Adult↗
PubMed1990

Psychiatric residents' educational experiences and attitudes toward eating disorders.

Our study of 180 psychiatric residents from all 16 Canadian psychiatric training centres showed that only 22.2% found university teaching on eating disorders adequate. Eighty-nine percent believed formal instruction on anorexia nervosa (AN) and bulimia nervosa (BN) should be made mandatory. Significantly more female than male residents were interested in AN and BN patients. The authors suggest special attention be given to residents' curriculum on the subject.

Adult↗