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This is the second article in a series comparing two patients treated in time-limited individual psychotherapy by a professional therapist in the Vanderbilt Psychotherapy Project. The patients were two young men suffering from anxiety, depression, and social withdrawal. One of the patients was a success case, the other a therapeutic failure. In addition to a variety of change measures, all tape-recorded therapy sessions were subjected to intensive study. Results showed that the outcome of psychotherapy depends markedly on the patient's ability to form a productive working relationship with the therapist early in therapy. Conversely, deep-seated characterological problems, manifesting themselves particularly in negativism, hostility, and other resistances, may give rise to insurmountable barriers resulting in negative therapeutic outcomes. The therapist's attitudes toward the patient and technical skill obviously play a part, but they appear to be overshadowed by the foregoing patient variables.
In 126 postmenopausal women with metastatic breast cancer, four chemotherapeutic combination programs were tested. Patients were stratified and randomized to one of the four programs: (1) fluorouracil, cytoxan and prednisone (CFP): (2) fluorouracil, cytoxan and Adriamycin (CAF); (3) cytoxan and Adriamycin (CA); or (4) alternating combinations of CFP-CA. Objective response rates were 17% for 18 patients on CFP, 25% for 40 patients on CAF, 42% for 41 patients on CA and 63% for 19 patients on CFP-CA. CFP-CA provided a significantly higher response rate than either CFP or CAF. The response rate of CA was intermediate. The duration of remission and survival were similar for all four groups. When progression or relapse following remission was demonstrated, patients were rerandomized to either adrenalectomy or tamoxifen. There were no responders either in the 15 patients undergoing adrenalectomy or the 11 patients receiving tamoxifen. In a crossover study, nine adrenalectomized patients received tamoxifen and four tamoxifen-treated patients underwent adrenalectomy. None responded. It appears that response rates to hormonal modalities are reduced in patients previously treated by combination chemotherapy.
Administered the Eysenck Personality Questionnaire (EPQ) and Psychological Screening Inventory (PSI) to a group of technical college students (N = 100) who were taking trade training courses. The groups were similar in terms of age and socioeconomic status. A factorial analysis was performed on both of the resulting sets of intercorrelations, and two factors were found to account for over 85% of the variance in each group. The first factor was common to both groups and was labelled neuroticism. While the second factor in the delinquent group clearly could be seen to be extraversion, the second factor in the student group was not interpreted easily, but appeared to be a dimension that represented psychiatric and antisocial problems.
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When using 'intent-to-treat' approaches to compare outcomes between groups in clinical trials, analysts face a decision regarding how to account for missing observations. Most model-based approaches can be summarized as a process whereby the analyst makes assumptions about the distribution of the missing data in an attempt to obtain unbiased estimates that are based on functions of the observed data. Although pointed out by Rubin as often leading to biased estimates of variances, an alternative approach that continues to appear in the applied literature is to use fixed-value imputation of means for missing observations. The purpose of this paper is to provide illustrations of how several fixed-value mean imputation schemes can be formulated in terms of general linear models that characterize the means of distributions of missing observations in terms of the means of the distributions of observed data. We show that several fixed-value imputation strategies will result in estimated intervention effects that correspond to maximum likelihood estimates obtained under analogous assumptions. If the missing data process has been correctly characterized, hypothesis tests based on variances estimated using maximum likelihood techniques asymptotically have the correct size. In contrast, hypothesis tests performed using the uncorrected variance, obtained by applying standard complete data formula to singly imputed data, can provide either conservative or anticonservative results. Surprisingly, under several non-ignorable non-response scenarios, maximum likelihood based analyses can yield equivalent hypothesis tests to those obtained when analysing only the observed data.
The effects of phentolamine (PH), sodium nitroprusside (NP) and nitroglycerin (GTN) were compared in experiments on anaesthetized cats. All three agents diminished vascular resistance and lowered blood pressure, although they differed in the intensity of their effects (NP greater than PH = GTN) and in the steepness of their dose-response curves (NP greater than PH greater than GTN). NP and GTN did not cause consistent changes in heart rate and dP/dt, whereas PH produced marked, dose-dependent increases in these two variables and in cardiac output, which was augmented to a lesser extent by NP and not affected by GTN. It is concluded that whereas the beneficial therapeutic effects of NP and GTN are presumably due exclusively to the reduction of preload and afterload, PH has an additional cardiostimulant action.
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The antiarrhythmic effects of mexiletine (n = 14) were compared to procainamide (n = 16) by a double-blind parallel protocol in 30 patients (group I) with frequent premature ventricular contractions (PVCs) (greater than 20/hr), and to amiodarone by an open-label sequential approach in 25 patients (mean left ventricular ejection fraction of 32.6 +/- 13.4%) with life-threatening ventricular arrhythmias (group II) resistant to two or more conventional agents. The predetermined end point of therapy in group I patients was met in 6 of 14 (43%) given mexiletine, with 7 (50%) requiring drug discontinuation for severe gastrointestinal or central nervous system side effects and only 3 of 16 patients (19%) given procainamide, with 5 (31%) developing limiting side effects. Increases in dose led to a higher efficacy rate for PVC suppression with a corresponding increase in side effects with mexiletine; with procainamide, the higher dose was not associated with greater PVC suppression. In group II patients, mexiletine was effective in 4 (16%), with one patient discontinuing the drug during long-term therapy; mexiletine was ineffective in 16 (64%) and early side effects developed in 5 (20%). Patients not responding to or not tolerating mexiletine were given amiodarone; 20 of 21 (95%) responded with arrhythmia control after the loading dose. During a mean follow-up period of 2 years, sudden death occurred in two patients, death from heart failure in two, and death from subarachnoid hemorrhage in one patient; 15 (75%) patients are alive and free of arrhythmia.(ABSTRACT TRUNCATED AT 250 WORDS)
The deacetylation of monoacetyldapsone (MADDS) was examined in liver microsomes and cytosol from male Sprague-Dawley rats, Golden Syrian hamsters, and Swiss Albino mice. All three rodent species demonstrated greater MADDS deacetylation activity in liver microsomes than in liver cytosol. Further investigations were conducted in hamsters. The velocity of MADDS deacetylation in major organs in the hamster was greatest in the intestine, followed by the liver and kidney. The effect of pretreatment with common inducers on liver microsomal deacetylation activity was also examined in the hamster. Phenobarbital, 100 mg/kg/day x 3 days, did not alter activity, while dexamethasone at the same dose reduced 2-acetylaminofluorene (2-AFF), MADDS, and p-nitrophenyl acetate (NPA) hydrolysis by at least 50%. Due to a previous report that KI activated the deacetylation of an arylacetamide in vitro (Khanna et al., J Pharmacol Exp Ther 262: 1225-1231, 1992), the effects of the halides KF, KCl, KBr and KI on MADDS hydrolysis in vitro were tested. Of the halides studied, only KF altered MADDS hydrolysis, resulting in an almost complete inhibition of deacetylase activity at 50 mM (with the initial concentration of MADDS at 0.6 mM) with an IC50 = 0.16 mM. Cornish-Bowden and Dixon plots indicated that the inhibition exerted by KF was non-competitive. The rank order of inhibitor potencies was constructed using phenylmethylsulfonyl fluoride (PMSF), bis(p-nitrophenyl)phosphate (BNPP), physostigmine, and KF with 2-AFF, MADDS, and NPA as substrates. Different rank order potencies were obtained for each of the substrates tested. The substrates 2-AFF, MADDS, and NPA did not act as competitive inhibitors on the hydrolysis rates of each other. Liver microsomal arylacetamide deacetylase activity was greater in male hamsters than in females with either MADDS or 2-AAF as substrates; however, hydrolysis of NPA was similar in both male and female hamsters. These data support the hypothesis that the enzyme which catalyzes the hydrolysis of MADDS differs from that catalyzing either 2-AAF or NPA hydrolysis.
Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs). The study design and methodology have been described in Part I. A total of 232 patients received comprehensive dental care including RPDs for 118 patients and FPDs for 114. Prespecified criteria determined treatment failures. During the 60-month period, treatment failures occurred in 19 FPD patients and 30 RPD patients. Ten FPD failures occurred before and nine after the FPD insertion. Five RPD failures were caused by abutment tooth loss and 25 for not using the RPD while eating. Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD. The 17.9% higher FPD success rate in Kennedy class II patients was both statistically and clinically significant. Excluding the 10 early failures, the 5-year FPD success rate was 91.5%. Of the 170 attempted implants, 26 failed, including 12 before the FPD fabrication. Radiographic assessments by a panel of three judges showed no bone deterioration during baseline to 60 months in 29.6%, slight in 25.4%, moderate in 15.9%, marked in 27%, and severe deterioration in 2.1% of the implant posts.
Five Veterans Administration Medical Centers participated in a study to determine the comparative influence of fixed partial dentures (FDPs) supported by endosteal blade implants and removable partial dentures (RPDs) on masticatory performance. The study design, methodology, and success rates have been described in Parts I and II. A total of 232 patients received comprehensive dental care, including RPDs for 118 patients and FPDs for 114. Three standardized masticatory tests were made with peanuts and carrots before treatment. These tests were repeated at 16 weeks following RPD or implant insertion and thereafter at 6, 18, 36, and 60 months. At entry, there were no significant differences in performance scores and chewing time and strokes taken to reach the swallowing threshold between the RPD and FPD groups (p greater than 0.05). After treatment completion, FPDs and RPDs significantly improved the masticatory ability of patients with Kennedy class I or class II edentulous conditions (p less than 0.001). The improvements in performance scores for both test foods were slightly better in the RPD group than in the FPD group, although none of the 30 mean differences was significant (p greater than 0.05). After the baseline period to 60 months, only slight changes in performance scores were observed for both groups. RPDs and FPDs were comparable in improving the chewing efficiency of patients with Kennedy class I and class II partially edentulous conditions.
This study compares treatment assessments made by two groups of patients with Kennedy class I or class II mandibular edentulous conditions, who received either a removable partial denture (RPD) (N = 115) or one or two fixed partial dentures (FPDs), each supported distally by a blade implant (N = 113). Two questionnaires were administered, one at 16 weeks after the implant or RPD insertion and at the 6-month interval and the other at 18, 36, and 60 months. Marked functional improvements were perceived by a large majority of patients in both groups after the insertion of prosthesis. At 6 months, a higher percent of patients with RPDs than those with FPDs found it easy to clean their RPDs and experienced chewing discomfort, restriction of food choices, feeling of insecurity with their RPDs, and difficulty with their pronunciation. The exclusion of assessments by 25 RPD patients, whose treatment was judged to be a failure functionally, made the mean differences between the two treatments statistically significant (p less than 0.05) only for ease of cleaning in favor of the RPD and fewer restrictions of food choices in favor of the FPD group. At 60 months, significant differences between the percents of patients with the most favorable responses occurred for perceptions of eating enjoyment, food particles seldom getting under the removable partial denture, and improvement in social life in favor of the FPD treatment and for the ease of cleaning the removable partial denture in favor of the RPD treatment. The results seem to support superiority of the FPD in terms of patient satisfaction, but not enough to favor this type of prosthesis over the RPD without consideration of other pertinent factors.
Percutaneous coronary intervention of saphenous vein grafts is associated with distal embolization. We aimed to compare potential differences in patients undergoing percutaneous coronary intervention for in-stent restenosis with de novo saphenous vein graft lesions. Myocardial necrosis was associated with higher mortality regardless of lesion type.