Prospective scenarios: A method of evaluating new decision tools

Prospective randomized controlled trials are rarely suitable for the evaluation of new decision making techniques. An approach is described in which a cohort of patients is taken down the usual study pathway to the point at which the new technique would be used. Conventional decision rules are then applied and the results recorded. The new technique is then deployed and the cohort reclassified. The logical and statistical justification for this approach is outlined. More rapid (although possibly less pure) analysis of the effect of the new technique is achieved.

---

Resumen Los estudios prospectivos, randomizados, y controlados raramente son adecuados para la valoración de nuevas técnicas de toma de decisiones. Se describe un enfoque en el cual una cohorte de pacientes es llevada a través del proceso de estudio hasta el punto en el cual la nueva técnica sería utilizada. En este momento se aplican las reglas convencionales de decisión y se registran los resultados; la nueva técnica es luego aplicada y la cohorte reclasificada. Se delinean la justificación lógica y estadística de este enfoque. Se la logrado un más rápido (aunque tal vez menos puro) análisis del efecto de la nueva técnica para el proceso de toma de decisiones.

---

Résumé Les essais prospectifs, randomisés, et contrôlés sont rarement adaptés à l'évaluation d'une technique de décision. L'approche décrite ici trace le cheminement classique d'étude avec lequel un groupe de patients est mené jusqu'au point où la technique nouvelle serait applicable. On enregistre alors les résultats de l'attitude décisionnelle classique puis on emploie la nouvelle technique et on redistribue les groupes. La justification logique et statistique de cette approche est définie. Une analyse plus rapide et peut-être moins rigoureuse des effets de cette nouvelle technique est pratiquée.

     

Attempts to develop radioactive anticancer drugs

Since 1953, attempts have been made to develop radioactive drugs. Preparations of tritiated menadiol sodium diphosphate (T-MNDP) of high specific activity showed a definite, though limited, but sometimes useful effect in the treatment of certain patients with advanced tumors, especially adenocarcinoms of the colon and of the pancreas and malignant melanoma of the skin. The next step was to use a much more effective isotope. 6-¹²⁵I-iodo-2-methyl-1,naphthoquinol bis (diammonium phosphate) - abbreviated 6-¹²⁵I-iodo-MNDP- has been synthesized, and in laboratory studies appears more promising. ¹²⁵I provides radiations which behave predominantly like high LET radiation, despite the accompanying X and gamma radiations. The astatine analogue, 6-²¹¹ At-astato-2rmethyl-1,4-naphthoquinol bis (disodium phosphate) has also been synthesized. Confirming and greatly extending the earlier findings with T-MNDP, n vitro experiments showed that 6-¹²⁵I-iodo-MNDP is concentrated selectively in the cells of some human malignant tumors by a factor of about 15 to 20 or more in relation to the cells of normal origin that were studied. Macrodosimetric considerations and comparison with clinical treatments with T-MNDP' suggest practical dosage. A typical treatment for a patient of body weight 70 kg with localized inoperable carcinoma of the colon could be 8 intravenous injections each of approximately 120mCi of 6-¹²⁵I-iodo-MNDP to a total of 0.97 Ci in 25 days. Risks of late carcinogenesis and leukemogenesis are calculated to be less than 1 %. Clinical indications are discussed briefly. Animal experiments are in progress and further preclinical studies are required.     

Use of radio-frequency pulsed energy in the control of postoperative reaction in blepharoplasty

This is a preliminary report of the use of a device to apply small pulses of radio-frequency energy to surgical wounds in order to improve wound healing. The device was applied to one eye in 21 patients who underwent bilateral blepharoplasty. There were no devicerelated complications. In 11 patients, edema and ecchymosis were noticeably less on the treated side within 24 hours of surgery. In 6 patients, ecchymosis and swelling were so slight that no difference between treated and untreated sides was visible. Two patients were noticeably worse on the treated side. Further studies will be conducted.