An alternative method for significance testing of waveform difference potentials

Guthrie and Buchwald (1991) proposed an ad hoc procedure for assessing the statistical significance of waveform difference potentials that may arise in a variety of psychophysiology research contexts. In our paper, an alternative method is presented and demonstrated that has fewer underlying assumptions than does the Guthrie-Buchwald test and may, therefore, produce better results in some situations. In particular, the test proposed here (a) is distribution free, (b) requires no assumption of an underlying correlation structure (e.g., first-order autoregressive), (c) requires no estimate of the population autocorrelation coefficient, (d) is exact, (e) produces p values for any number of subjects and time points, and (f) is highly intuitive as well as theoretically justifiable. This procedure may be used to carry out multiple comparisons with exact specification or experimentwise error, however, this test is based on permutation principles and may require large amounts of computer time for its implementation.     

Evaluation of the impact of recent changes in postgraduate continuing education for community pharmacists in England

Postgraduate continuing education for community pharmacists in England has undergone a radical change since the establishment of the Centre for Pharmacy Postgraduate Education (CPPE) in 1992. The present study was undertaken to assess the impact of the introduction of the CPPE on levels of participation and attitudes towards continuing education. Comparisons are drawn with an analysis made in 1991. Results showed that 76.8 per cent of respondents had participated in CPPE-based continuing education, as either workshops or distance learning. This level of participation is far higher than that previously recorded. Those pharmacists who attended the workshops also tended to request distance learning packages, while a significant proportion of users of distance learning declined to attend workshops. Owners of community pharmacies were significantly more likely than managers to use computer assisted learning material. Attitudes concerning restraints against participation in continuing education focused on the value pharmacists place on their spare time and the absence of a postgraduate education allowance for community pharmacists.     

A phase I/II study of continuous infusion suramin in patients with hormone-refractory prostate cancer : toxicity and response

 Introduction: Suramin is a synthetic polysulfonated naphthylurea which has been used for the treatment of African trypanosomiasis and onchocerciasis, but since the mid-1980s has received attention as a possible antiretroviral and antineoplastic agent. Objective: This clinical trial of suramin was undertaken as a phase I/II study in patients with hormone-refractory prostate cancer, with the hypothesis that the intensity of therapy with suramin could be increased significantly if measures were undertaken to maintain the plasma concentrations of the drug under 300 μg/ml. Methods: We report the clinical results of this trial, wherein patients were treated at three different targeted plasma suramin concentrations (275, 215 and 175 μg/ml) for varying periods of time (2, 4 or 8 weeks), with delivery of the drug by continuous intravenous infusion. Results: The major toxicity observed in this trial was neurologic, consisting of a motor and sensory peripheral neuropathy that resulted in both paresis and paralysis of the limbs. Nearly all of this severe (CTEP grade III, IV) neurologic toxicity was observed in the patients treated at a plasma suramin concentration of 275 μg/ml for 4 or more weeks. A single patient treated at 215 μg/ml for 8 weeks developed moderate (CTEP grade III) proximal lower extremity weakness, and no patient treated at 175 μg/ml developed this toxicity. The second most common toxicity observed was infection of the central venous catheter. The overall response rate for all of the evaluable patients was 17% (13 of 75 patients). In addition, prostate-specific antigen (PSA)-defined responses were observed in six patients receiving therapy at 175 μg/ml, but these responses were confounded by cessation of therapy with flutamide during suramin treatment. Conclusions: In summary, although plasma suramin concentrations were maintained below 300 μg/ml, neurologic toxicity nonetheless occurred with high frequency in patients treated at 275 μg/ml for 4 or more weeks. Therapy at 215 and 175 μg/ml was in general well tolerated, but central venous catheter-related infection, as well as the inconvenience and expense of continuous infusional therapy, make this method of drug delivery impractical. Only moderate antitumor activity was observed during this trial, but it is possible that both continuation of flutamide and flutamide withdrawal during suramin therapy confounded the assessment of suramin’s activity in hormone-refractory prostate cancer. Received: 9 June 1995/Accepted: 18 March 1996     

Definitive treatment to pyriform sinus with minimum cord exposure--a case report

In every Radiation Oncology Department there is a group of patients referred for curative radiotherapy and within this group of patients there is a subset of patients who present the most difficult of treatment scenarios, maximum tumor dose and minimum spinal cord dose. The case to be presented involved the use of a head and neck five field technique of which three fields were treated isocentrically with the remaining two fields being electron boosts. It is from these patients that we extend to the maximum our planning capabilities.     

Irritable infant syndrome: theoretical perspectives and practice implications

Conceptually weak and unsubstantiated theories attempting to explain the origins of infant colic have led to inconsistent and ineffective approaches to the management of the infant with persistent crying. A new theoretical perspective that views excessive crying as a developmental behavioral disorder is presented. The clinical implications of this model for nurses working with families of irritable infants are discussed.     

Complications of vasovasostomy

Microsurgical vasovasostomy has become a common urologic procedure. A successful anastomosis is related to good mucosal alignment and a water-tight anastomosis rather than to a specific technique. The presence of vasal or epididymal sperm granulomas as well as antisperm antibodies will also influence postoperative pregnancy rates.