Drug resistance in ovarian cancer: from the laboratory to the clinic

OBJECTIVE: To provide a review of the basic mechanisms of drug resistance in ovarian cancer and novel strategies to modulate drug resistance for the general obstetrician-gynecologist. DATA SOURCES: Relevant articles published through December 1996 were identified using the MEDLINE data base. Additional sources were found by cross-referencing. METHODS OF STUDY SELECTION: Publications identified by the search were reviewed and evaluated critically for their relevance to drug resistance in ovarian cancer. TABULATION, INTEGRATION, AND RESULTS: Each reference was reviewed for its contribution to the knowledge regarding mechanisms of chemotherapy resistance in ovarian cancer or strategies to modulate resistance. CONCLUSION: Ovarian cancer patients have high response rates to initial chemotherapy after cytoreductive surgery. However, most will develop resistance to chemotherapy during the course of their treatment. There are multiple mechanisms resulting in drug resistance. Strategies to modulate drug resistance include dose intensity, various pharmacologic agents, and gene therapy.     

AIDS: nursing care, new perspectives

OBJECTIVES: To revise the recent changes which have occurred in the diagnosis of, clinical stay for, and treatment of AIDS and their repercussions in nursing care. 1997 was characterized by the clear dominance of new advances in combined therapy using antiretorvirus drugs, by the possibility to measure the degree and number of the virus infection, and an improved knowledge of the dynamics and variability of the AIDS virus. Infected persons' quality of life can benefit from nursing care to check the gradual physical, cognitive and emotional deterioration patients continue to suffer from, in spite of the tenuous hope which new scientific discoveries and advances have introduced and which are very slowly becoming a part of treatment programs. SOURCES FOR THIS STUDY INCLUDE: MEDLINE data base studies published between 1990 and 1996, regular "SEISIDA" publications; summaries from the XIth International AIDS Conference held in Vancouver in July 1996; reports published by the Centers for the Control and Prevention of Diseases (CDC); and articles published or pending publication written by the authors. ARTICLE SELECTION: Selection of original articles published from 1990 to 1996 on the MEDLINE data base dealing with nursing treatment for patients infected by HIV in hospital, community center or homecare service units.     

A descriptive analysis of the Journal of Manipulative and Physiological Therapeutics, 1989-1996

BACKGROUND: Two previous reports have summarized the content, institutional affiliations, academic training and funding sources for articles published in the Journal of Manipulative and Physiological Therapeutics (JMPT) from 1978-1986 and 1987-1988. OBJECTIVES: (a) to quantitatively assess the types of articles published in the JMPT from 1989-1996; (b) to identify the affiliations of contributors to the JMPT during this period; (c) to identify the academic backgrounds of contributors to the JMPT from 1989-1996; (d) to identify funding sources for scholarly works published in the JMPT during this period; (e) to identify the proportionate contributions of female authors; (f) to assess the proportion of articles contributed, i.e., foreign vs. domestic sources; and (g) to compare findings for the JMPT from 1989-1996 with similar data for 1978-1988. STUDY DESIGN: Survey of the contents of the JMPT from 1989-1996. METHODS: The contents of the 69 issues of the JMPT from 1989-1996 were reviewed by all authors. Characteristics extracted included category of the article, academic backgrounds of authors, institutional affiliations of authors, funding sources, gender of authors and nation(s) of origin of articles. RESULTS: The annual rate of published contributions to the Journal has more than doubled compared with its first 11 yr of publication, and the proportion of original data reports has grown slightly. Controlled and quasicontrolled clinical trials were 7 times more numerous (n = 28 articles) during the past 8 yr. Chiropractic colleges were the most frequently mentioned affiliation of authors, followed by private practice and nonchiropractic colleges. Collaborative articles submitted by authors at two or more chiropractic colleges grew from only 4 articles from 1978-1988 to 31 articles from 1989-1996. As in previous years, the National College of Chiropractic continued to be the most frequently mentioned academic affiliation of authors. The numbers of articles contributed by those holding scientific (e.g., PhD) and medical degrees have grown substantially. The number of articles mentioning financial support grew from 78 from 1978-1988 to 179 from 1989-1996, and 58 new funding sources were identified. The Foundation for Chiropractic Education and Research continues to be the most frequently mentioned source of funding. Of all articles published in the JMPT from 1989-1996, 21% were authored or coauthored by women. Of 1050 articles, 286 (27%) were authored or coauthored by individuals residing outside the United States of America. CONCLUSIONS: Substantial increases in scholarly activities within the chiropractic profession are suggested by the growth in scholarly products published in the discipline's most distinguished periodical. Increases in controlled outcome studies, collaboration among chiropractic institutions, contributions from nonchiropractors, contributions from nonchiropractic institutions and funding for research suggest a degree of professional maturation and growing interest in the content of the discipline.     

Efficacy of estrogen therapy in urinary incontinence. A meta-analytic study

OBJECTIVE: To analyze by meta-analysis the results of randomized controlled clinical trials on the efficacy of estrogen treatment in menopausal patients with urinary incontinence. STUDY DESIGN: Meta-analysis. MATERIALS AND METHODS: Randomized controlled clinical trials, published from January 1965 to December 1996, on estrogen therapy in patients with urinary incontinence, were selected. They included: trials with placebo vs estrogen therapy, studies on menopausal patients with confirmed diagnosis of urinary incontinence based on clinical and/or urodynamic tests, studies with sufficient statistical informations on the results obtained and with information about subjective and objective outcome. RESULTS: Out of 72 articles reviewed, 7 were selected and only 4 were considered on the basis of the requested criteria. Subjective outcome was statistically different in patients treated with estrogen therapy compared with patients treated with placebo. Objective clinical and urodynamic outcome was not statistically different in the two types of treatment (estrogen vs placebo treatment). CONCLUSIONS: There were few published randomized controlled studies on estrogen therapy in patients with urinary incontinence in medical literature. Different results between subjective and objective outcome showed by meta-analysis, could be explained either by an estrogen induced unperceivable improvement not registered by clinical and instrumental parameters or by insufficient systems used to collect subjective data. Therefore, it is suggested that, for future research, randomized controlled clinical trials on topical or transcutaneous systemic estrogen treatment with a more than 6 months follow-up will be carry out.     

Bibliometric analysis of the original articles published in the Revista Espa?ola de Anesthesiología y Renimación in 10 years (1987-1996)

OBJECTIVE: To describe the original research articles published in Revista Espa?ola De Anestesiología y Reanimación (REAR) from 1987 through 1996, as well as to characterize the citations included in those articles. MATERIAL AND METHODS: The 299 articles published as original research in REAR over the past 10 years (1987 through 1996) were analyzed. The bibliographic aspects examined were coauthorship (authors/paper index), citations per article, isolation in function of language of publication of references, degree of obsolescence of articles based on year of references cited ("half-life"), self-citation and degree of dispersion of citations. RESULTS: The authors/paper index was 5.16 +/- 1.62. No statistically significant difference was found in number of authors over the 10-year study period. Mean number of references cited per article was 24.05 +/- 12.02. We found statistically significant differences for 1993 and the period 1987 to 1988, and 1994 and the year 1987 (p < 0.001). The "half-life" of articles was 6 when analyzing on a year-by-year basis; this index ranged from 5.5 to 7, with no significant annual differences. REAR articles accounted for 4.02% of all citations. English was the most frequent language of cited publications, with 6,240 references (86.8%), followed by Spanish with 621 (8.64%), French with 223 (3.1%) and German with 74 (1.03%). Of the 7,191 references analyzed, 6,447 (89.65%) were of scientific journals. Books are the second most commonly cited type of document, with 623 (8.66%) citations. Analyzing journals cited 25 or more times, we found that 74.19% of the articles (4,783/6,447) had been published in 5.3% of the journals (36/678). Seven journals of anesthesia, which represented 1.03% of all journals (7/678) appeared in 52.81% of references of this type (3,405/6,447). CONCLUSIONS: The number of authors of original research articles published in REAR in the last 10 years was high. Spanish authors in anesthesiology cite mainly literature in English; use up-to-date sources of information, mainly journals; and take a large proportion of information from a small number of journals, which are those of greatest international impact in our specialty.     

The effect of autocorrelation on the results of visually analyzing data from single-subject designs

OBJECTIVE: Single-subject research designs are used to conduct clinical research and outcome evaluation in occupational therapy. Confusion exists regarding the best method to analyze and interpret single-subject data. METHOD: One hundred graphs displaying the results of published single-subject research were examined to determine the influence of autocorrelation on the visual inferences made by the original investigators. The graphs were selected from 20 articles published over 10 years in seven rehabilitation journals. The data were extrapolated and lag 1 autocorrelation coefficients computed for both the baseline and treatment phases. RESULTS: Data analysis focused on two issues: (a) whether a relationship existed between the amount of autocorrelation present in a graph and the conclusion on the basis of visual analysis and (b) whether the amount of autocorrelation varied across different phases of the single-subject graphs. When a significant degree of autocorrelation was present, researchers using visual analysis were more likely to conclude that there was no clinically significant change in performance. Autocorrelation values were significantly higher in the treatment phases of the single-subject designs. CONCLUSION: Additional research is needed to establish a set of decision rules to assist clinicians in using visual analysis to evaluate the results of single-subject research.     

Craniocerebral trauma: protection and retrieval of the neuronal population after injury

OBJECTIVE: To review the consequences of mechanical injury to the brain with an emphasis on factors that may explain the variability of outcomes and how this might be influenced. METHODS: Information regarding the pathophysiology of traumatic brain damage contained in original scientific reports and in review articles published in recent years was reviewed from the perspective of a clinical neurosurgeon and a neuropathologist, each with major research interests in traumatic brain damage. The information was compiled on the basis of the knowledge of and personal selection of articles that were identified through selective literature searches and current awareness profiles. A systematic literature review was not conducted. RESULTS: Mechanical input affects neuronal and vascular elements and is translated into biological effects on the brain through a complex series of interacting cellular and molecular events. Whether these lead to permanent structural damage or to resolution and recovery is determined by the balance between processes that, on the one hand, mediate the effects of initial injury and subsequent secondary insults and, on the other, are manifestations of the brain's protective, reparative response. Experimental and clinical research has identified opportunities for altering the balance in a way that might promote recovery, but data demonstrating that this can lead to substantial clinical benefit are lacking. Recent evidence of genetically determined, individual susceptibility to the effects of injury may explain some of the puzzling variability in outcome after apparently similar insults and may also provide new opportunities for treatment. CONCLUSION: The understanding of traumatic brain damage that is being gained from recent research is widening and broadening perspectives from the traditional focus on mechanical, vascular, and metabolic effects to encompass wider, neurobiological issues, drawn from the fields of neurodevelopment, neuroplasticity, neurodegeneration, and neurogenetics. Neurotrauma is a fascinating area of neuroscience research, with promise for the translation of knowledge to improved clinical management and outcome.     

Pelvic inflammatory disease: diagnosis and management

BACKGROUND: Acute pelvic inflammatory disease (PID) is a major gynecologic health problem in the United States, afflicting more than 1 million women each year and generating annual direct and indirect costs estimated at $4.2 billion. Family physicians can play an important role in the prevention, as well as diagnosis and treatment, of PID. METHODS: A MEDLINE search for articles published from 1985 to the present was made using the key words "pelvic inflammatory disease," "endometritis," "salpingitis," "tubo-ovarian abscess," "adnexitis," "pelvic abscess," "parametritis," and "oophoritis." The bibliographies of these articles and the author's personal files were also sources of information. RESULTS AND CONCLUSIONS: A number of risk factors have been linked to PID, including young age, age at first intercourse, multiple sex partners, the presence of bacterial vaginosis, vaginal douching, the use of an intrauterine contraceptive device, and a history of a sexually transmitted disease. The diagnosis of PID represents a major clinical challenge that requires a careful history and physical examination coupled with selective and knowledgeable use of the diagnostic tests and procedures currently available. Broad-spectrum antibiotics, which represent the cornerstone of therapy, must adequately cover the polymicrobial spectrum of pathogens implicated in this infection, which includes Neisseria gonorrhoeae, Chlamydia trachomatis, and specific cervicovaginal anaerobic and aerobic bacteria. The numerous sequelae associated with PID, which include infertility, ectopic pregnancy, and chronic pelvic pain syndromes, underscore the need for effective measures for preventing pelvic inflammatory disease.     

Joining science and application: Ethical challenges for researchers and practitioners.

The Ethical Principles of Psychologists and Code of Conduct (American Psychological Association [APA], 1992) stresses the importance of a scientific base for professional practice and implementation of research procedures that protect participant welfare. This article examines 3 ethical concerns flowing from the science-practice relationship: (1) Does current research provide a scientific base for psychological interventions? (2) Do psychologists have an empirical foundation for addressing the needs of diverse populations? (3) Is the welfare of psychologically vulnerable research participants protected? A survey of 323 articles published in APA journals during 1991 indicates the need to increase the scientific evaluation of psychological treatments, the documentation of client and practitioner characteristics as they relate to service delivery, and the enlistment of practitioners in referral procedures for research participants in need of psychological treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic representation in a sample of the literature of applied psychology.

A number of authors have raised concerns over the external validity of psychological research. This study examined the extent to which empirical articles include human participants from diverse ethnic backgrounds. Articles published over a 5-year period in 14 selected journals representing 3 applied subdisciplines of psychology were examined. Of the 2,536 articles coded, only 61 % indicated the ethnicity of the participants. For those articles, the ethnic compositions approximated U.S. Census estimates, with the exception of an overrepresentation of African Americans and an underrepresentation of Hispanic Americans. The results imply that although the field is apparently adequately recruiting English speakers, representation of non-English speakers should be increased. To further enhance the external validity of psychological research, ethnicity of participants should be not only specified but also analyzed in relation to the results of a study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A hierarchical approach to inferences concerning interobserver agreement for multinomial data

BACKGROUND AND PURPOSE: The purpose of this study was to evaluate the interobserver and intraobserver reliability of assessments of impairments and disabilities. SUBJECTS AND METHODS: One physical therapist's assessments were examined for intraobserver reliability. Judgments of two pairs of therapists were used to examine interobserver reliability. Reliability was assessed by Cohen's kappa. RESULTS: Of the 42 impairments and disabilities assessed by the physical therapist in the intraobserver reliability study, kappa values could be calculated for 33 items. For 31 items (94%), kappa values ranged from .40 to .91, and 2 items (6%) had kappa values of less than .40. To determine interobserver reliability, 37 items were assessed in one practice. Kappa values could be calculated for 34 items, with 30 items (88%) having kappa values ranging from .41 to .80 and 4 items (12%) showing "poor" agreement. In the second practice, 47 items were assessed for interobserver reliability. Kappa values could be calculated for 40 items, with 11 items (27.5%) having kappa values ranging from .41 to .84. Poor agreement was shown for the remaining 29 items (72.5%). CONCLUSION AND DISCUSSION: Assessments of impairments and disabilities are potentially reliable. The differences between practices of the interobserver reliability study can be explained by the fact that one of the therapists did not receive training in the use of the assessment form. More generalizable conclusions will require further study with more subjects and therapists.     

Clients' perceptions of helpful experiences in counseling.

The question of what clients experience as helpful in counseling was examined via concept mapping, a methodological approach combining qualitative and quantitative strategies. The purpose of the study was to clarify the scope and interrelations among elements of the retrospective experience of helpfulness among 36 clients who had completed counseling after an average of 11 sessions. Five thematic clusters consistent with previous research were identified: Counselor Facilitative Interpersonal Style, Counselor Interventions Generating Client Resources, New Perspectives, and Client Self-Disclosure. Four new thematic clusters were also identified: Emotional Relief, Gaining Knowledge, Accessibility, and Client Resolutions. The structure of the concept map generated by the participants in this study was found to be consistent with an integrative, pantheoretical model of the counseling process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cues and concerns by patients in medical consultations: A literature review.

The aim of the current article is to review the peer-reviewed research literature on cues and concerns published between 1975 and 2006. To be included, articles had to report observational studies based on patient-physician consultations and report findings on patient expressions of cues and/or concerns. Quantitative and qualitative studies from different medical settings were considered. Fifty-eight original articles based on the analysis of audio- or videotaped medical consultations were tracked down. Definition of cues and concerns and methodological approaches differed widely. Physicians missed most cues and concerns and adopted behaviors that discouraged disclosure. Communication training improved the detection of cues and concerns. Future research progress would require different methodological approaches more appropriate for studying verbal interactions and the complexity of the various levels that influence interactions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inferential and advanced analysis of research data

This study was undertaken to determine which biomedical journals contain articles written by podiatric physicians and in which indexing sources such articles are likely to appear. A survey was conducted of the 20 most frequently published podiatrist authors from a selected group of podiatric journals during the period from 1990 to 1995. Articles published by these authors during the study period were examined to determine where they had appeared. The MEDLINE database was found to contain the largest number of citations to articles written by these podiatric physicians. Both the Podiatry Index and Embase are also very good sources of citations to podiatric medical literature and should be used to supplement MEDLINE searches.