Program evaluation in the public interest: a new research methodology

For every social welfare or social control service program there are several parties, each with different interests: patients, clients, staff, management, and sponsors. Evaluation of such a program in the public interest must take the interests of these parties into account. To do so requires an untraditional methodology, that of a second-person, or communal, science, which is not above the conflict of parties and their interests in specifying the variables, staffing the research, balancing considerations of intrusion against those of bias, considering the action implications of the data, sequentially staging the research, or even publishing findings. This all makes evaluation in the public interest a highly political process often unlikely to be logically decisive about intervariable relationships, to yield generalizable results, or even to be completed.     

Psychotherapy outcome research: An application of a new method for evaluating research methodology.

Reviewed 142 psychotherapy outcome studies published in 21 journals between 1978 and 1985, focusing primarily on psychotherapy as a treatment of emotional problems, but including articles regarding the use of psychotherapy as a treatment for other problems (e.g, marital discord). Of concern was whether the methodological rigor of published psychotherapy outcome studies had improved since 1978: Results fail to indicate significant overall improvement or deterioration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coma in fulminant pneumococcal meningitis: new MRI observations

We report a 45-year-old man with fulminant pneumococcal meningitis. Fluid attenuated inverse ratio MR images showed the ravaging consequences of occlusive vasculopathy and a transient purulent basal exudate. Bilateral thalamic lesions may have explained the failure to awaken despite appropriate antibiotic therapy.     

Social network analysis: A new methodology for counseling research.

Social network analysis (SNA) is a set of procedures that use indices of relatedness among individuals to produce representations of social structures and positions inherent in dyads or groups. This approach differs from traditional research strategies in that the focus is on developing an understanding of the ongoing transactions and the implications of transactional patterns between individuals, groups, or other social units. Although the primary emphasis in SNA is on the social context, network analysts also include traditional individual-differences variables as potential explanatory factors. SNA methods provide the means to derive a more complete view of a given social environment. A group-psychotherapy example is used to provide an overview of SNA, introducing the concepts, notation, and statistical methods used by the current generation of network researchers. Methodological issues are discussed, applications are reviewed, and resources are recommended for those wishing to learn more about SNA. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MnPcS4: a new MRI contrast enhancing agent for tumor localisation in mice

Manganese-tetrasulfonated phthalocyanine (MnPcS4) has been evaluated as a potential contrast agent in Magnetic resonance imaging (MRI) for tumor localisation in mice. MnPcS4 showed favourable molar relaxivity, much better than Gd-DTPA and comparable to tetrasulfonated manganese complex of porphyrin (TPPS4). Tumors showed selective retention of the metal complex (dye) with the peak value reached at 24 hours following intravenous administration. Dye concentration in tumors remained consistently higher than either kidney or muscle tissue both at 1 and 24 hours and a 10-fold increase in tumor-to-muscle ratio over the control was seen at 24 hr. Normal liver tissue, however, showed higher concentration than tumor at all times during the study. A linear correlation was found between longitudinal relaxation rate (1/T1) and the corresponding concentration of MnPcS4 in various tissues. MR imaging done in animals using 1.5 T superconducting clinical imager showed a mean percent increase in signal intensity of 131.8% (SD +/- 32.86) in the tumor and a 70% increase in tumor-to-muscle ratio over the pretreatment value, at 24 hr. The results suggest that MnPcS4 is a potential tumor-selective contrast agent in MRI.     

Multiple sclerosis: use of MRI in evaluating new therapies

11q23 translocations (t(11q23)) are recurring cytogenetic abnormalities in both acute myeloid leukemia (AML) and acute lymphoblastic leukemia, involving the same gene, ALL1 (or MLL). Mixed lineage antigen expression has been reported in these leukemias, but its frequency and clinical significance are unknown. We immunophenotyped leukemia cells from 19 adult de novo AML patients with t(11q23) by multiparameter flow cytometry. Translocations included t(6;11)(q27;q23), t(9;11)(p22;q23), t(9;11;19)(p22;q23;q13.3), t(2;11)(11;17)(q37;q11q23;q11), t(11;17)(q23;q25), t(11;19)(q23;p13.1), t(11;19)(q23;p13.3) and t(11;22)(q23;q11). FAB types were M4 and M5. The committed stem cell and myeloid antigens HLADr, CD4dim, CD11b, CD13, CD15, CD32, CD33, CD38 and CD64 were each expressed in 80-100% of cases, and the early stem cell and lymphoid antigens CD34, CD56, CD3, CD2 and CD7 in 42, 39, 16, 5 and 5%, respectively. Antigen expression frequencies did not differ from those in 443 adequately karyotyped M4 and M5 cases without t(11q23). Fifteen patients (79%) attained complete remission (CR); median CR duration and survival were 10.0 and 15.1 months. CR duration and survival did not correlate with antigen expression. In particular, patients with t(9;11) survived longer than those with other t(11q23) (median not reached vs 7.6 months; P = 0.048), but antigen expression did not differ in the two groups. Thus frequencies of lymphoid antigen expression are similar in AML with t(11q23) and in other FAB M4 and M5 cases, treatment outcome does not differ in t(11q23) cases with and without lymphoid antigen expression, and better outcome of patients with t(9;11) compared to other t(11q23) does not correlate with differences in antigen expression. Mixed lineage antigen expression is not a distinctive feature of AML with t(11q23).     

Constructivism: a naturalistic methodology for nursing inquiry

This article will explore the philosophical underpinnings of the constructivist research paradigm. Despite its increasing popularity in evaluative health research studies there is limited recognition of constructivism in popular research texts. Lincoln and Guba's original approach to constructivist methodology is outlined and a detailed framework for nursing research is offered. Fundamental issues and concerns surrounding this methodology are debated and differences between method and methodology are highlighted.     

Simultaneous multislice acquisition using rosette trajectories (SMART): a new imaging method for functional MRI

OBJECTIVES: Despite the recent introduction of new peroral drugs as well as neurosurgical methods for Parkinson's disease, treatment of late stage parkinsonian patients remains difficult and many patients become severely handicapped because of fluctuations in their motor status. Injections and infusions of apomorphine has been suggested as an alternative in the treatment of these patients, but the number of studies describing the effects of such a treatment over longer time periods is still limited. The objective was to investigate the therapeutic response and range of side effects during long term treatment with apomorphine in advanced Parkinson's disease. METHODS: Forty nine patients (30 men, 19 women; age range 42-80 years) with Parkinson's disease were treated for 3 to 66 months with intermittent subcutaneous injections or continuous infusions of apomorphine. RESULTS: Most of the patients experienced a long term symptomatic improvement. The time spent in "off" was significantly reduced from 50 to 29.5% with injections and from 50 to 25% with infusions of apomorphine. The quality of the remaining "off" periods was improved with infusion treatment, but was relatively unaffected by apomorphine injections. The overall frequency and intensity of dyskinesias did not change. The therapeutic effects of apomorphine were stable over time. The most common side effect was local inflammation at the subcutaneous infusion site, whereas the most severe were psychiatric side effects occurring in 44% of the infusion and 12% of the injection treated patients. CONCLUSION: Subcutaneous apomorphine is a highly effective treatment which can substantially improve the symptomatology in patients with advanced stage Parkinson's disease over a prolonged period of time.     

Medical dictionaries for patient encoding systems: a methodology

Medical language is highly compositional and makes extensive use of common roots, especially Latino-Greek roots. Besides words devoted to common sense, medical language presents some typical characteristics, especially on morphological and semantic aspects of word formation. Morphological decomposition and identification precedes semantic analysis. It is only when these two prerequisites are fulfilled that an attempt to grasp the meaning of a whole expression is made possible. The main aim of the proposed approach is that of coping with 'the lack of coverage of the medical lexical knowledge', in order to help physicians find the correct international classification for diseases (ICD) codes for a written diagnosis. The proposed methodology allows the development of a powerful dynamic dictionary dedicated to natural language processing in the field of diagnoses and narrative procedures. It describes the design of an analyser that can profit from a dictionary. The methods used have proved to be efficient for various classifications, s well as for multiple languages, as the system presently supports French, German, English and Dutch for ICD-9 and ICD-10 classifications.     

High-resolution MRI of pancreatic masses with a new circularly polarized body phased-array coil

A total of 18 patients with clinical suspicion of a pancreatic tumor underwent dynamic contrast-enhanced CT and MRI examinations. A fat-suppressed T1-weighted 2D fast-low-angle-shot (FLASH) sequence and a T2-weighted spin-echo (SE) sequence were applied in a transverse orientation using a circularly polarized (CP) body phased-array coil. The FLASH sequence was repeated after Gd-DTPA administration. The highest spatial resolution was 1.37 x 1.37 x 3.00 mm3. In two cases a half Fourier single-shot turbo-SE sequence (HASTE) was additionally applied. In a comparison between CT and MRI, pancreatic masses could be demonstrated and characterized with excellent image quality. The fat-saturated 2D FLASH sequence yielded the highest contrast-to-noise ratios after Gd-DTPA administration between pancreas and inflammatory or neoplastic lesion. One non-contour deforming carcinoma could be detected only with MRI and was only retrospectively visible on CT with an element of uncertainty. Magnetic resonance imaging using a CP body phased-array coil and fat-suppressed T1- and T2-weighted FLASH, SE, and turbo-SE sequences offers diagnostic possibilities in improved imaging of the pancreas.     

A new methodology for the preoperative localization of occult insulinomas

This study describes clinical aspects, treatment, and survival times of 52 dogs with hemangiosarcoma of the spleen, presented at the Department of Veterinary Surgery, University of Munich, Germany. Depending on the dissemination of the disease the dogs were assigned to three clinical stages: 10 dogs were in stage I (tumor confined to the spleen without metastasis), 18 in stage II (tumor confined to the spleen or ruptured, with or without lymph node involvement but without distant metastasis) and 24 in stage III (with distant metastasis). Dogs in stage I displayed mild and nonspecific symptoms. In stage II and II, half of the patients were presented in shock or collapse after an acute rupture of the tumor. Sonographic examination was found superior in diagnosing splenic neoplasia when compared to radiography. Pronounced laboratory abnormalities were present mainly in patients in stages II or III with anemia, leucocytosis, thrombocytopenia and prolonged bleeding times predominating. Survival times following splenectomy were very variable. The median survival time was 100 days. Because of the high standard deviaton there was no statistically significant difference in survival times between animals of different stages.     

Digital image ratio: a new radiographic method for quantifying changes in alveolar bone. Part II: Clinical application

BACKGROUND: Men with benign prostatic hyperplasia can be treated with alpha 1-adrenergic-antagonist drugs that relax prostatic smooth muscle or with drugs that inhibit 5 alpha-reductase and therefore reduce tissue androgen concentrations. However, the effects of the two types of drugs have not been compared. METHODS: We compared the safety and efficacy of placebo, terazosin (10 mg daily), finasteride (5 mg daily), and the combination of both drugs in 1229 men with benign prostatic hyperplasia. American Urological Association symptom scores and peak urinary-flow rates were determined at base line and periodically for one year. RESULTS: The mean changes from base line in the symptom scores in the placebo, finasteride, terazosin, and combination-therapy groups at one year were decreases of 2.6, 3.2, 6.1, and 6.2 points, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). The mean changes at one year in the peak urinary-flow rates were increases of 1.4, 1.6, 2.7, and 3.2 ml per second, respectively (P<0.001 for the comparisons of both terazosin and combination therapy with finasteride and with placebo). Finasteride had no more effect on either measure than placebo. In the placebo group, 1.6 percent of the men discontinued the study because of adverse effects, as did 4.8 to 7.8 percent of the men in the other three groups. CONCLUSIONS: In men with benign prostatic hyperplasia, terazosin was effective therapy, whereas finasteride was not, and the combination of terazosin and finasteride was no more effective than terazosin alone.     

Familial etiology of schizophrenia: Is a scientific methodology possible?

The 3 major research approaches toward identifying familial etiological factors in schizophrenia are examined from a methodological viewpoint. Both the clinical observational and retrospective recall methods are judged to be inadequate. The 3rd approach, direct observation and recording of family interactions, is concluded to be free of intrinsically disqualifying inadequacies, given the limiting assumption that the variables under investigation are etiological in nature. Although the limitations of this assumption can only be overcome by a longitudinal approach, family interaction studies are considered to be an indispensable, practical precondition to the formulation of longitudinal studies. Results from a subset of methodologically adequate studies are examined and conclusions drawn. Several cautions and recommendations for future research are offered. (2 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

MRI of intramedullary sarcoidosis: follow-up of a case

Significative enhancement of free radical formation (FRO) in vivo is an important feature of hypertensive disorders of pregnancy (HDP), namely preeclampsia (PIH). The latest investigations about the pathology of HDP, showed the contribution of placental circulation to the development and evolution of such disease. The placental bed can be a potential source of FRO or activation of cells that can produce FRO. Glutathione, is an important molecule for cellular protection against damage, is a cofactor of many enzymes, in particular, for the glutathione peroxidase of the placental tissue; this enzyme in the placenta bed prevent the production of thromboxan and lipoperoxides; the latter are potentially damaging to the endothelium cells and can cause vasoconstriction, the most important feature of PIH. The activity of that enzyme is deficient in PIH. We studied, by fluorometric assay, the concentrations of the two states of glutathione in placental homogenates (PLH) from pregnant women without pathology (PWN) and from pregnant women with PIH (PWPIH). The data showed significant low concentrations in the PLH of the two states of glutathione in the PWN against high concentrations of this molecule in the PLH from PWPIH. This feature can result from a deficient user of the glutathione by the cellular mechanism for prevention against oxidative factors. In addition, our study shows a biochemical marker that is suggestive that the placental bed is a potential source of FRO production in PIH.