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Biomedical subjects

R Dar

Publications and source records attributed to R Dar.

17 recordsLinked to original sources
PubMed2001

The role of surgery and postoperative chemoradiation therapy in patients with lymph node positive esophageal carcinoma.

BACKGROUND: Patients who have undergone resection for lymph node positive esophageal carcinoma are at high risk of disease recurrence and early death. The role of postoperative adjuvant therapy in this population needs to be determined. METHODS: A retrospective review of all patients with resected esophageal carcinoma between 1991 and 1997 was performed. Lymph node positive (N1) patients who received concurrent or sequential postoperative radiotherapy (50 grays) and chemotherapy (cisplatin, 5-fluorouracil with or without epirubicin) were compared with N1 patients who underwent surgery alone. The disease free and overall survival rates were calculated using the Kaplan-Meier method, and groups were compared with the log-rank test. Prognostic variables were entered into a Cox regression model controlling for age, weight loss, T status, Eastern Cooperative Oncology Group (ECOG) score, and treatment received. RESULTS: A total of 165 patients were reviewed: Twenty-eight N1 patients underwent surgery alone (S group), and 38 N1 patients underwent surgery and received postoperative chemoradiation therapy (CRT group). Preoperative risk factors, tumor characteristics, ECOG scores, and lengths of hospital stay were similar. The disease free survival rates were similar (S group, 10.6 months; CRT group, 10.2 months), although the S group had more local disease recurrences (S group, 35%; CRT group, 13%; P = 0.09). The overall survival rate according to the Kaplan-Meier analysis showed a significant survival advantage with postoperative CRT radiation (log-rank test; P = 0.001). The median overall survival for the CRT group was 47.5 months, which was significantly longer than that of the S group (14.1 months). The ECOG score, T status, and treatment received all were found to influence survival significantly on univariate analysis. In the multivariate model, postoperative CRT was a predictor of survival (P = 0.007; risk ratio for mortality, 0.35; 95% confidence interval, 0.16-0.76) and was correlated with a significantly decreased risk of death in patients with lymph node positive, resected esophageal carcinoma. CONCLUSIONS: Postoperative CRT appears to prolong survival in patients with lymph node positive, resected esophageal carcinoma.

Aged↗
PubMed2000

Realism of confidence in obsessive-compulsive checkers.

The study examined whether obsessive-compulsive (OC) checkers have reduced confidence in their knowledge. OC checkers were compared with panic disorder (PD) patients and nonpatient controls using a calibration-of-knowledge procedure. Participants completed a general knowledge questionnaire, rated their confidence in each answer, and estimated the total number of correct answers. These responses were converted to 2 measures of confidence relative to performance--over/underconfidence and over/underestimation. OC checkers had lower scores than nonpatients did on both measures, whereas the PD patients did not differ from either group. For the OC checkers, relative confidence was inversely related to the severity of obsessions. The authors speculate that confidence may depend on a confirmation bias in testing hypotheses and that the reduced confidence in OC checkers may reflect a disconfirmation bias in this population.

Adult↗
PubMed2000

Compulsivity and obsessionality in opioid addiction.

Seventy-one individuals with opioid dependence undergoing ambulatory treatment participated in a personal interview assessing the importance of their opioid-use rituals, the severity of compulsivity and obsessionality in relation to their drug use, and the number of obsessive compulsive disorder (OCD) symptoms. The level of compulsivity and obsessionality in opioid dependence was comparable to that found in OCD and alcohol addiction. The importance of rituals was inversely related to the number of opioid lapses during rehabilitation treatment and positively correlated with the number of non-drug-related OCD symptoms. Based on established norms for OCD symptoms, we estimated that 11.4% of our sample would meet diagnostic criteria for OCD, a rate which is over 4 times higher than the rate of OCD in the general population.

Adult↗
PubMed1999

Advantages of bias and prejudice: an exploration of their neurocognitive templates.

Bias is common in mental-processing tasks as diverse as target recognition, heuristic estimation and social judgment. This paper holds that cognitive biases stem from the covert operation of neural modules, which evolved to subserve adaptive behavior. Such modules can be innate or forged early in development. Research shows links between (i) biases in cognitive tasks and (ii) neural devices, which may mediate them. Evidence is included from biases that arise spontaneously in artificial neural networks during recognition/decision tasks. Two linked propositions follow. First, there are continuities in biasing strategies across different levels of cognitive processing. Second, a proclivity for stereotyping and prejudice depends on the biased functions of lower-level neural modules that promote adaptations to social environments. The propositions rest on evidence of biological preparedness for stereotyping and of deficits in social judgment in patients with neurological lesions. To test such claims, research studies are suggested at the boundary of cognitive neuroscience and social psychology. Advantages of bias and prejudice as evolved tools may include their: (1) speeding of scrutiny and improving of target detection in changing or uncertain situations; (2) aiding of a rapid choice of practical short-term rather than optimal longer term plans; (3) allowing appraisal of a workable world by creating fairly stable categories; (4) motivating of exploration and completion of problem-solving which might otherwise be abandoned too early. The biological priming of social biases need not mean that they are immutable; understanding them could lead to better ways of controlling them.

Cognition↗
PubMed1996

High prevalence of personality disorders among circadian rhythm sleep disorders (CRSD) patients.

The purpose of this study was to examine systematically our previous clinical impression regarding the prevalence of personality disorders in patients suffering from circadian rhythm sleep disorders (CRSD). We hypothesized that, in a group of patients suffering from CRSD, there would be a higher frequency of personality disorders than in a group of healthy controls. The experimental group consisted of CRSD patients diagnosed according to a clinical interview and actigraphic recordings. The control group consisted of healthy volunteers in whom CRSD had been ruled out by means of a self-administered questionnaire. Both groups were assessed for personality disorders using the MCMI, a diagnostic tool based on Millon's biopsychosocial theory of personality and the PRQ-R, a diagnostic tool based on the DMS-III-R. Both tests provided clear and significant support for the hypothesis that individuals suffering from CRSD are characterized to a greater extent by personality disorders than a control group. No specific characteristic pattern or profile of personality disorders was clearly detected. Correct early diagnosis and treatment of CRSD may improve afflicted individuals' adaptive capabilities and perhaps even prevent the development of a personality disorder. This suggests how important a greater awareness of CRSD on the part of the professional community may be.

Adolescent↗
PubMed1995

Obsessive-compulsive disorder in a birth cohort of 18-year-olds: prevalence and predictors.

OBJECTIVE: To report descriptive epidemiological information on obsessive-compulsive disorder (OCD) in an unselected birth cohort of 930 males and females, aged 18 years. METHOD: An epidermiological study of the prevalence of self-reported OCD at age 18, and a longitudinal analysis of the prospective predictors of OCD. RESULTS: Using the Diagnostic Interview Schedule, the authors found a 1-year prevalence rate of 4%, with a male-female ratio of 0.7:1. The majority of OCD cases met criteria for a comorbid disorder, most commonly depression (62%), social phobia (38%), and substance dependence (alcohol 24%, marijuana 19%). CONCLUSIONS: Data collected on the sample from birth to age 18 years indicated that many childhood risk factors theorized in the literature did not predict OCD in this sample. However, a history of depression and substance use were prospective risk factors for OCD.

Adolescent↗
PubMed1994

Misuse of statistical test in three decades of psychotherapy research.

This article reviews the misuse of statistical tests in psychotherapy research studies published in the Journal of Consulting and Clinical Psychology in the years 1967-1968, 1977-1978, and 1987-1988. It focuses on 3 major problems in statistical practice: inappropriate uses of null hypothesis tests and p values, neglect of effect size, and inflation of Type I error rate. The impressive frequency of these problems is documented, and changes in statistical practices over the past 3 decades are interpreted in light of trends in psychotherapy research. The article concludes with practical suggestions for rational application of statistical tests.

Humans↗
PubMed1992

Cancer pain in the marital system: a study of patients and their spouses.

Forty married patients with metastatic cancer, who were receiving opioid medication for cancer pain, were interviewed for this study. They were asked about their pain and its treatment, their beliefs regarding cancer pain, their concerns about opioid analgesics, their mood state, and the nature of their interaction with their spouse in relation to these issues. The spouses of these cancer patients were interviewed separately about the same issues. For example, patients who were concerned about medication side effects tended to suffer high levels of pain before requesting additional analgesics. Spouses are shown in this study to be an important support for the patient and an essential source of information regarding the patient's pain and its management. For example, although spouses were generally accurate in their estimates of the patients' pain levels, in the case of relatively stoic patients, who may underreport their pain levels, the spouses' estimates were higher than the patients'. The results also indicate that patients underestimate the distress their pain causes to their spouses and that spouses tend to downgrade their own support to the patients. Implications and limitations of these findings are discussed.

Adult↗
PubMed1992

Changing trends in three decades of psychotherapy research: the flight from theory into pragmatics.

This article reviews 252 empirical studies of psychotherapy published in the Journal of Consulting and Clinical Psychology in the years 1967/1968, 1977/1978, and 1987/1988. Articles were rated on variables related to theoretical relevance, clinical validity and methodology. It is shown that the main trend over this period of time has been a decline in theory-guided and a rise in pragmatic, clinically oriented research. Related changes in specific norms and practices in this area are illustrated. The disadvantages of a purely empirical approach to psychotherapy research are discussed, and recommendations are made in light of the distinction between the different aims of pragmatic and theoretical research.

Cognitive Behavioral Therapy↗
PubMed1992

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗
PubMed1987

Fluvoxamine treatment of obsessive-compulsive disorder.

Sixteen outpatients who met DSM-III criteria for obsessive-compulsive disorder completed a 20-week double-blind, crossover trial with fluvoxamine and placebo. Thirteen (81%) improved with fluvoxamine, while three (19%) improved with placebo. Fluvoxamine treatment was associated with significant improvement on measures of obsessive-compulsive symptoms, anxiety, and depression. Depressed subjects' improvement on obsessive-compulsive measures correlated with improvement in symptoms of depression. Nondepressed subjects also showed improvement on measures of obsessive-compulsive symptoms. In this trial, fluvoxamine was an effective and safe treatment for obsessive-compulsive disorder.

Adolescent↗
PubMed1986

Factors influencing physician management of cancer pain.

It has been asserted that pain due to cancer is not adequately managed, and that physician attitudes may contribute to poor management. Based on responses to questionnaire items assessing attitudes that have been identified as affecting the quality of pain management, two groups of physicians were identified using cluster analysis on selected questionnaire items, and the responses of the two clusters to questions concerning their approach toward pain management were compared. With reference to reported practice, Cluster I physicians (N = 19) were willing to prescribe more potent analgesics and to do so earlier in the course of the disease as compared to Cluster II (N = 72). Cluster I members reported using more modalities of pain therapy, and more often saw scheduled analgesics as appropriate for the management of cancer pain. Groups did not differ in composition of medical specialty, nor in number of cancer patients cared for. More "liberal" attitudes toward pain management were associated with younger age and with more experience in specialized oncology units.

Adult↗
PubMed1985

Public attitudes toward cancer pain.

This study examined public attitudes toward pain associated with cancer and its treatment. A variety of issues were assessed, including the extent to which pain is associated with cancer, fear of pain as a factor in the decision to delay seeking treatment, and concerns about the use of narcotic analgesics for pain control. A statewide sample of 496 adult Wisconsin residents completed a telephone interview. It was found that cancer was perceived as an extremely painful disease relative to other medical conditions. Eighteen percent of the respondents reported that they might be reluctant to seek medical attention due to fear of pain. Concerns about disease- and treatment-related pain were rated as significant psychosocial concerns. There were multiple concerns expressed about the consequences of using narcotic analgesics for pain control. Implications for public education and patient management are discussed.

Analgesics, Opioid↗