Platinum and anthracycline therapy for advanced cutaneous squamous cell carcinoma

Because metastatic cutaneous squamous cell carcinoma (CSCC) is rare, standard chemotherapy has not been fully established. In Japan, combination platinum and anthracycline chemotherapy has been used for elderly patients with advanced CSCC because of its low toxicity. However, the clinical benefit of this therapy has not been fully examined. We retrospectively examined the response rate of combination platinum and anthracycline chemotherapy for metastatic CSCC. Eight patients received combination chemotherapy for metastatic lesions; there were lymph node lesions in 6 patients and skin and lung lesions in one patient each. The combination regimens were as follows: cisplatin (CDDP) (60-90 mg/m(2)/day, day 1) and adriamycin (ADM) (20-40 mg/m(2)/day, day 1 or 2) was administered in 5 patients; CDDP (10-15 mg/m(2)/day, days 1-5) and epirubicin (epi-ADM) (10-15 mg/m(2)/day, days 1-5) was administered in 2 patients; and carboplatin (CBDCA) (200-400 mg/m(2)/day, day 1) and ADM (20-40 mg/m(2)/day, day 1 or 2) was administered in one patient. The responses were as follows: complete response in 2 patients (CDDP + ADM for lung metastasis, CDDP + epi-ADM for lymph node metastasis), partial response in 1 (CDDP + ADM for lymph node metastasis), stable disease in 2, and progressive disease in 3. A durable response was observed in 2 patients showing complete responses (58 and 112 months). The clinical effect of the combination of platinum and anthracycline for metastatic CSCC was limited despite the findings of two patients showing durable complete responses.ArticleINTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY. 18(3):506-509 (2013)journal articl

Predicting utilization of evidence-based parenting interventions with organizational, service-provider and client variables

Multidisciplinary service providers (N = 611) who underwent training in the Triple P-Positive Parenting Program participated in a structured interview 6 months following training to determine their level of post-training program use and to identify any facilitators and barriers to program use. Findings revealed that practitioners who had received training in Group Triple P, received positive client feedback, had experienced only minor barriers to implementation, and had consulted with other Triple P practitioners following training were more likely to become high users of the program. Practitioners were less likely to use the program when they had lower levels of confidence in delivering Triple P and in consulting with parents in general, had difficulties in incorporating Triple P into their work, and where there was low workplace support. These findings highlight the importance of considering the broader post training work environment of service providers as a determinant of subsequent program use

Dynamic Impedance Model of the Skin-Electrode Interface for Transcutaneous Electrical Stimulation

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Transcutaneous electrical stimulation can depolarize nerve or muscle cells applying impulses through electrodes attached on the skin. For these applications, the electrode-skin impedance is an important factor which influences effectiveness. Various models describe the interface using constant or current-depending resistive-capacitive equivalent circuit. Here, we develop a dynamic impedance model valid for a wide range stimulation intensities. The model considers electroporation and charge-dependent effects to describe the impedance variation, which allows to describe high-charge pulses. The parameters were adjusted based on rectangular, biphasic stimulation pulses generated by a stimulator, providing optionally current or voltage-controlled impulses, and applied through electrodes of different sizes. Both control methods deliver a different electrical field to the tissue, which is constant throughout the impulse duration for current-controlled mode or have a very current peak for voltage-controlled. The results show a predominant dependence in the current intensity in the case of both stimulation techniques that allows to keep a simple model. A verification simulation using the proposed dynamic model shows coefficient of determination of around 0.99 in both stimulation types. The presented method for fitting electrode-skin impedance can be simple extended to other stimulation waveforms and electrode configuration. Therefore, it can be embedded in optimization algorithms for designing electrical stimulation applications even for pulses with high charges and high current spikes

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups, 3 parent focus groups, and 10 youth semi-structured interviews. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate support and lack of family involvement; however, parents and therapists, in particular, identified different contributing factors to these barriers. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research

Toward cost-effective staffing mixes for Veterans Affairs substance use disorder treatment programs

BACKGROUND: In fiscal year (FY) 2008, 133,658 patients were provided services within substance use disorders treatment programs (SUDTPs) in the U.S. Department of Veterans Affairs (VA) health care system. To improve the effectiveness and cost-effectiveness of SUDTPs, we analyze the impacts of staffing mix on the benefits and costs of specialty SUD services. This study demonstrates how cost-effective staffing mixes for each type of VA SUDTPs can be defined empirically. METHODS: We used a stepwise method to derive prediction functions for benefits and costs based on patients’ treatment outcomes at VA SUDTPs nationally from 2001 to 2003, and used them to formulate optimization problems to determine recommended staffing mixes that maximize net benefits per patient for four types of SUDTPs by using the solver function with the Generalized Reduced Gradient algorithm in Microsoft Excel 2010 while conforming to limits of current practice. We conducted sensitivity analyses by varying the baseline severity of addiction problems between lower (2.5 %) and higher (97.5 %) values derived from bootstrapping. RESULTS AND CONCLUSIONS: Compared to the actual staffing mixes in FY01-FY03, the recommended staffing mixes would lower treatment costs while improving patients’ outcomes, and improved net benefits are estimated from $1472 to$17,743 per patient

The role of practitioner self-efficacy, training, program and workplace factors on the implementation of an evidence-based parenting intervention in primary care

This study examines factors affecting the implementation by primary care practitioners (nursing, education, allied health, and medical) of a brief parenting and family support intervention (the Primary Care Triple P-Positive Parenting Program) following professional training. It assesses the impact of prior experience, self-efficacy, program supports, program barriers, satisfaction with training, and workplace characteristics on reported extent of program use. The majority of practitioners (97%) reported using Triple P following training. Implementation was assessed as the proportion of cases seen who received the full program. Program supports (quality of format and materials) and barriers (management difficulties and lack of fit) impacted on practitioner self-efficacy, and higher self-efficacy was positively associated with implementation. Prior professional experience, satisfaction with training, and workplace factors were not significant predictors. These results highlight the importance of promoting practitioners' sense of competence or mastery of a program for facilitating the implementation of evidence-based programs in primary care settings