Differences In Patient Background Research Articles

肺アスペルギルス症の発症リスクコントロール要因―入院環境と抗真菌剤選択の重要性―

In patients with blood diseases, maintaining a proper ward environment as regards temperature and humidity and effective drug treatment are important in preventing the development of deep mycosis. We investigated the influences of temperature and humidity and use of antifungal agents on the incidence of pulmonary aspergillosis in such patients. The subjects were 132 patients admitted to our hematology ward between January 1999 and December 2004. Of the 132 patients, 22 developed pulmonary aspergillosis but 110 did not. There were no significant differences in patient background between these patients. The incidence of pulmonary aspergillosis was high (observed significance level of test : 0.004) during summer when the mean humidity in the ward was high. Administration of the antifungal agent micafungin for prevention or treatment reduced incidence (observed significance level of test : 0.042). Based on these findings, we conclude that proper control of ward humidity and selection of an effective antifungal agent are important factors in reducing the incidence of aspergillosis in wards where patients are being treated for blood diseases.

Comparison of the clinical outcome after hormonal therapy for prostate cancer between Japanese and Caucasian men

To investigate the impact of race on the effectiveness of hormonal therapy in patients with prostate cancer, by comparing the outcomes of Caucasian men (CM) and Japanese-American men (JAM) treated with hormonal therapy at one institution. Fifty-nine CM and 105 JAM with prostate cancer were treated with hormonal therapy at The Queen's Medical Center in Honolulu. Age, stage, Gleason score, race, and pretreatment PSA levels were abstracted. The Kaplan-Meier method was used to construct overall and cause-specific survival curves, which were compared using log-rank statistics. These factors were assessed as to their interdependence and correlation with the clinical course using a Cox proportional hazards regression model. Although there were no statistical differences in patient background, JAM who had received hormonal treatment had a better outcome than CM for overall and cause-specific survival rate (P = 0.001 and 0.036, respectively). Race was one of the significant prognostic factors in the multivariate analysis (P = 0.03). The findings suggest a difference in the effectiveness of hormonal therapy for prostate cancer in JAM living in Hawaii compared to CM. There were marked racial differences in clinical outcome after hormonal therapy between JAM and CM. A prospective study with more patients might be necessary to elucidate the differential effectiveness of hormonal therapy for prostate cancer in different races, especially between Japanese and Caucasians.

Effectiveness of microlaparoscopy in the diagnosis of premature ovarian failure

Premature ovarian failure (POF) cases contain a mixture of cases possessing follicles (type A) and those depleted of follicles (type B). Differentiation between the two types is important because the treatment policy and pregnancy prognosis vary greatly. The objective of this study was to examine the usefulness of microlaparoscopy in the differentiation of types A and B. Among 66 patient with POF diagnosed at our department between May 1996 and April 2004, 47 patients who gave informed consent and underwent microlaparoscopy were studied. The cases were divided into four groups based on the laparoscopic ovarian morphology. These groups were analyzed with respect to patient background, blood hormone levels, antinuclear antibody positive rate, visualization of the ovary on transvaginal ultrasonography, presence or absence of follicles in biopsy specimen, and number of follicles. No significant differences in patient background and serum hormone levels were observed between groups. There was a tendency of increase in antinuclear antibody positive rate, increase in proportion of cases with follicles, and increase in number of follicles as the ovarian morphology approached normal. Transvaginal ultrasonography failed to identify the ovary in all the patients. Microlaparoscopy is useful in the differentiation between type A and B POF, and is further expected to become an indicator of response to treatment.

糖尿病を合併した新鮮ＮＢｅｌｌ麻ひの臨床的検討 ｓｔｅｒｏｉｄ療法とｌｉｐｏ ＰＧＥ１療法の比較検討

This study was designed to compare large dose steroid therapy and lipo-PGE1therapy in 22 previously untreated patients with Bell's palsy accompanied by diabetes mellitus. Thirteen patients were treated with large dose steroid therapy, while the remaining 9 were treated with Lipo-PGE1 therapy. No significant differences in patient backgrounds, such as age, sex, and the side of palsy, were present between the two treatment groups. Furthermore, no significant differences in the mean palsy score at the time of presentation or at the time of aggravation were present between the two groups. Cumulative recovery rates after treatment did not differ significantly at 4 weeks or at 2 and 6 months between the two groups, nor were there any differences in the therapeutic outcomes between the groups. Fasting blood glucose levels during the period of treatment were elevated in all 13 patients receiving steroids, but not in the lipo-PGE1 group. Diabetes mellitus was also aggravated in the steroid group, but not in the lipo-PGE1 group. These findings indicate that lipoPGE1 therapy improves the blood flow to facial nerves, promoting recovery from Bell's palsy. Furthermore, lipoPGE1, therapy is useful for the treatment of Bell's palsy accompanied by diabetes mellitus because it has the same recovery rate as that of large dose steroid therapy, but it does not aggravate diabetes mellitus.

The psychotherapist matters: Comparison of outcomes across twenty-two therapists and seven patient samples.

This research relies on a useful focus for finding the contribution of the psychotherapist to the outcome of the treatment: the outcomes of each therapist's caseload. Our data consist of 22 therapists' caseloads within seven samples of drug-addicted and depressed patients. We concluded that (a) there were important differences in the improvement levels and post-treatment outcomes of patient caseloads among the therapists sampled, and (b) these differences in improvement could not be explained by differences in patient background or severity. Some of the differences appeared to reflect the therapists' efficacy with their patients because (a) a unique feature of the design was that three therapists took part in more than one study and therefore more than one caseload; these three therapists showed a similar efficacy in each new caseload, (b) At this time, it may be that the safest basis for choosing therapists for research studies or for clinical purposes is their “work sample” record of efficacy with their previous caseloads.