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Biomedical subjects

W Fisher

Publications and source records attributed to W Fisher.

At least 37 records · Page 2Linked to original sources
PubMed1995

Cisplatin plus etoposide with and without ifosfamide in extensive small-cell lung cancer: a Hoosier Oncology Group study.

PURPOSE: To determine whether the addition of ifosfamide to cisplatin plus etoposide improves the response rate, time to disease progression, or overall survival in previously untreated patients with extensive-stage small-cell carcinoma of the lung (SCLC). PATIENTS AND METHODS: Patients with extensive SCLC with a Karnofsky performance score (KPS) > or = 50 and adequate renal function and bone marrow reserve were eligible. Patients with CNS metastases were eligible and received concurrent whole-brain radiotherapy. Patients were randomized to receive cisplatin (20 mg/m2) plus etoposide (100 mg/m2) (VP) both given intravenously (i.v.) on days 1 to 4 or cisplatin (20 mg/m2), ifosfamide (1.2 g/m2), and etoposide (75 mg/m2) (VIP) all given i.v. on days 1 to 4. Cycles were repeated every 3 weeks for four cycles. RESULTS: From May 1989 through March 1993, 171 patients were randomized (84 to VP and 87 to VIP). The median follow-up duration is 26 months. All patients were assessable for survival; 163 were fully assessable for response and 162 for toxicity. Myelosuppression was greater with VIP. Objective responses were observed in 55 of 82 (67%) and 59 of 81 (73%) assessable patients treated with VP and VIP, respectively (difference not significant). The difference in the median time to progression was statistically different (P = .039). The median survival times on VP and VIP were 7.3 months and 9.0 months, respectively (P = .045 for survival curves by stratified log-rank test) with 2-year survival rates of 5% versus 13%, respectively. CONCLUSION: VIP combination chemotherapy is associated with an improved time to progression and overall survival over VP therapy in patients with extensive SCLC.

Adult↗
PubMed1995

Phase III trial of thoracic irradiation with or without cisplatin for locally advanced unresectable non-small-cell lung cancer: a Hoosier Oncology Group protocol.

PURPOSE: Here we report the results of a phase III study, to evaluate whether the addition of cisplatin to radiation therapy (XRT) would improve progression-free survival or overall survival for patients with locally advanced unresectable non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Two hundred forty patients with biopsy-proven unresectable NSCLC without distant metastases or lower-stage medically inoperable patients were randomized to one of two treatment arms. Arm A consisted of thoracic XRT alone, 60 to 65 Gy total tumor dose in daily fractions of 1.80 to 2.00 Gy; and arm B consisted of identical XRT with the addition of cisplatin 70 mg/m2 every 3 weeks for three cycles beginning on the first day of irradiation. RESULTS: Two hundred fifteen patients were eligible and assessable. The overall response rate was 50% on the combination arm versus 38% on the XRT-alone arm (P = .076). The median progression-free survival time was 23 versus 22 weeks, respectively (P = .0537). The median survival time was 43 weeks on the combination arm versus 46 weeks on the XRT arm (Poverall = .3469). The 1-, 2-, and 5-year survival rates were 43%, 18%, and 5% on the combination arm versus 45% 13%, and 2% on the XRT arm, respectively. CONCLUSION: Cisplatin, administered every 3 weeks, does not significantly improve response rate, progression-free survival, or overall survival when added to thoracic XRT for locally advanced unresectable NSCLC.

Adult↗
PubMed1995

Dental hygienists' information seeking and computer application behavior.

A questionnaire requesting information on information seeking, critical analysis, and computer applications was returned in 1992 by 136 of 197 (69 percent) currently licensed dental hygienists residing in Alaska, Delaware, and Idaho. The most common sources used for professional development and information retrieval were continuing education courses, discussions with colleagues, and journals. The respondents' own experience, credibility of the journal, and discussions with colleagues were the most frequent methods used to evaluate professional information. Many hygienists owned or had access to a computer, yet they rarely conducted online database searches to obtain professional information. The computer was primarily used to perform business functions rather than for clinical applications in these dental hygienists' employment settings. The majority of these hygienists were interested in attending related continuing education courses and indicated that computer skills should be part of dental hygiene curricula.

Adult↗
PubMed1995

Information-seeking practices of dental hygienists.

This paper reports on a survey of the information-seeking, critical-analysis, and computer-application practices of dental hygienists. Questionnaires were mailed to a convenience sample of seventy-one dental hygiene practitioners. A 62% response rate was achieved. Results indicated that discussions with colleagues, continuing education courses, journals, and newsletters were the sources used most frequently for professional development and information retrieval. To evaluate professional information, these hygienists tended to rely on personal experience, credibility of the journal, and discussions with colleagues. Word processing was the most frequently used computer application; online database searching was rare in this group. Computer used within the employment setting was primarily for business rather than clinical applications. Many hygienists were interested in attending continuing education courses on use of computers to acquire professional information.

Adult↗
PubMed1993

Teaching self-feeding skills to patients with Rett syndrome.

Few studies have examined the extent to which functional hand-use may be taught to girls with Rett syndrome after those skills have been lost. In this investigation, five females with classic Rett syndrome were taught to feed themselves using a method of prompting and reinforcement. All patients demonstrated improvements in their self-feeding skills. The results are discussed in terms of the factors that may influence the acquisition of skills in girls with Rett syndrome, and directions for future research and proposed.

Adolescent↗
PubMed1993

Functional communication training with and without extinction and punishment.

Functional communication training has been reported to be a promising treatment for severe behavior problems. In this study, functional communication training alone and combined with extinction and/or punishment was evaluated for 4 clients with severe retardation, behavior problems, and communication deficits. The participants were inpatients on a hospital unit for treatment of severe behavior disorders. They received individualized interventions based on functional assessment that included reinforcement of a communication response with the same function as their destructive behavior. Results showed that for some patients, functional communication training was not sufficient to produce clinically significant reductions in destructive behavior, and the combination of training plus punishment produced the largest and most consistent reductions.

Adult↗
PubMed1993

A water-prompting procedure for the treatment of urinary incontinence.

Based on clinical observations of a naturally occurring phenomenon, a water-prompting procedure was used to facilitate toilet training with a 9-year-old boy with profound mental retardation. Other frequently used toilet-training procedures were either ineffective or were associated with increased self-injury. The water-prompting treatment package may increase continence by eliciting and reinforcing urination under specific stimulus conditions.

Child↗
PubMed1992

A comparison of two approaches for identifying reinforcers for persons with severe and profound disabilities.

The development of effective training programs for persons with profound mental retardation remains one of the greatest challenges for behavior analysts working in the field of developmental disabilities. One significant advancement for this population has been the reinforcer assessment procedure developed by Pace, Ivancic, Edwards, Iwata, and Page (1985), which involves repeatedly presenting a variety of stimuli to the client and then measuring approach behaviors to differentiate preferred from nonpreferred stimuli. One potential limitation of this procedure is that some clients consistently approach most or all of the stimuli on each presentation, making it difficult to differentiate among these stimuli. In this study, we used a concurrent operants paradigm to compare the Pace et al. (1985) procedure with a modified procedure wherein clients were presented with two stimuli simultaneously and were given access only to the first stimulus approached. The results revealed that this forced-choice stimulus preference assessment resulted in greater differentiation among stimuli and better predicted which stimuli would result in higher levels of responding when presented contingently in a concurrent operants paradigm.

Child↗
PubMed1991

Educational achievement in non-verbal children: are they learning disabled?

From a data-base of all nonspeaking children in North Dakota we analyzed the data on those children functioning above the retarded range to determine the prevalence of children meeting the main inclusion criteria for learning disabilities (LD), a severe discrepancy between IQ and achievement. The mean IQ for this group of 38 nonspeaking, nonretarded children of 104.0 was significantly higher than IQ equivalent scores in the academic subjects of reading (66.4), math (70.4), written language (65.2), and spelling (71.2). Using a stringent criterion for an IQ-achievement discrepancy of 2 standard deviations, 27 of 38 (71%) met this criterion in at least one subject. Academic subjects dependent upon higher linguistic functioning, written language and reading, were more affected than spelling and math. While the vast majority (73%) of these 38 children were deaf, the prevalence of IQ-achievement discrepancies was also found in 57% of the nonspeaking children without hearing impairments. These data suggest the common practice of excluding a diagnosis of a learning disability in a deaf child on the basis of the child's hearing impairment may not be appropriate. Further research is needed on the role of speech in academic achievement.

Achievement↗
PubMed1991

Behavioral treatment of sleep dysfunction in patients with the Rett syndrome.

Aberrant sleep patterns are commonly experienced by girls with the Rett syndrome. In this investigation, the problematic sleep of three girls with the Rett syndrome was regulated using a bedtime fading procedure with response cost. The treatment involved systematically delaying the bedtime and utilized a response cost component, removing the child from bed for one hour, when the child did not experience short latency to sleep onset. Daytime sleep was interrupted, except during regularly scheduled naps. A fading procedure was then successfully utilized to advance the bedtimes. This treatment resulted in more regular sleep patterns for the girls by increasing appropriate nighttime sleep, reducing inappropriate daytime sleep and reducing problematic nighttime behaviors (e.g., night wakings). These preliminary findings are important because they suggest that the dysfunctional sleep patterns of girls with the Rett syndrome may be amenable to behavioral treatments.

Behavior Therapy↗
PubMed1991

Reinforcement of incontinent stools in the treatment of encopresis.

In this paper, fecal incontinence and constipation were treated in two mentally retarded individuals using a novel intervention wherein incontinent stools were first rewarded in order to increase the frequency of bowel movements. This intervention was implemented only after more traditional pediatric and behavioral treatments were unsuccessful. The reinforcement of incontinent stools procedure resulted in an increase in both the frequency and the number of continent stools for both individuals. Hypotheses regarding the failure of previous treatments and the success of the current treatment are discussed as well as directions for future research.

Adolescent↗
PubMed1991

Pulmonary complications of combination therapy with cyclophosphamide and prednisone.

Oral cyclophosphamide and prednisone are standard treatment for some neoplasms and necrotizing systemic vasculitis and are advocated with increasing frequency for idiopathic interstitial lung disease. During a 15-month period, we observed four cases of acute respiratory failure from Pneumocystis carinii pneumonia (PCP) in patients treated with oral cyclophosphamide and prednisone. One patient each had polyarteritis nodosa, Wegener's granulomatosis, bronchiolitis obliterans with organizing pneumonia, and chronic lymphocytic leukemia with red blood cell aplasia. Hypoalbuminemia (serum albumin level less than 3.0 g/dl) and daily therapy were associated with increased risk for development of PCP (p less than 0.05). None of the patients had leukopenia (less than 3,500/cu mm) or neutropenia (less than 1,000/cumm) at diagnosis. All were negative for the human immunodeficiency virus. Patients receiving oral cyclophosphamide and prednisone may be at higher or increasing risk for PCP. A high index of suspicion and aggressive evaluation for opportunistic infection are needed in these patients; consideration for trimethoprim-sulfamethoxazole prophylaxis and development of more quantitative measures of immunosuppression are needed.

Aged↗