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Hands JM, Whalen M, Haji-Momenian S, Frazier H, Andrawis R, Jarrett T, Provenzano D, Bauman JE, Estephan F, Aghdam H, Chen D, Goyal S, Ojong-Ntui M, Rao YJ. Focal Boosted IMRT Treatment of Prostate Cancer to 84 Gy in 28 Fractions: Preliminary Clinical Outcomes and Dosimetry. Int J Radiat Oncol Biol Phys 2023; 117:e390. [PMID: 37785313 DOI: 10.1016/j.ijrobp.2023.06.2513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The FLAME trial reported that focal boosting of prostate tumor to 95 Gy in 35 fractions improves biochemical control. However, this treatment is not commonly used in the United States. We investigated a focally boosted treatment of 84 Gy in 28 fractions (EQD2 108 Gy, BED 252 Gy). MATERIALS/METHODS Between 2019-2022, men with unfavorable intermediate risk (uIR) and high risk (HR) prostate cancer were enrolled on a prospective registry and received a novel IMRT regimen. The dose levels were 84 Gy to the gross tumor volume (GTV) as defined on mpMRI (T2W and ADC) with no added margin, 70 Gy to the prostate and proximal seminal vesicles, and optional 50.4 Gy to elective pelvic lymph nodes (all 28 fractions). Patients received fiducial markers and hydrogel spacer. The treatment planning goal was to cover 95% of the GTV at 84 Gy, and also meet the target and normal tissue dosimetry criteria of the hypofractionated treatment arm of NRG-GU005. VMAT was used for treatment delivery. ADT was given at the discretion of the treating physician. RESULTS A total of 20 men were included in the study, 2 (10%) uIR and 18 (90%) HR. 9 (45%) tumors were GS 7, 7 (35%) were GS 8, and 4 (20%) were GS 9. There were 13 (65%) stage cT1, 4 (20%) cT2 and 3 (15%) cT3. One (5%) patient received short term ADT, 18 (95%) long term ADT, and 1 (5%) refused ADT. 18 (90%) men received elective nodal radiation. The mean baseline PSA was 25.1 (range 4.2-73.4). The median baseline IPSS score was 11.1 (IQR 4.5-12), and 4 patients had severe baseline urinary symptoms (IPSS ≥20). The mean baseline prostate volume was 57.4 cc (range 26.8-198.3). The mean volume of the 84 Gy boost target was 7.1 cc (range 2.3-15.0) and the mean proportion of the prostate boosted was 14.8% (range 2% - 47%). There were 10 (50%) men with 1 boost target, 6 (30%) with two, 3 (15%) with three, and 1 (5%) had 4 boost targets. Targets were located in peripheral zone (85%), transition zone (30%), and central zone (5%). Patients met all per-protocol normal tissue criteria of NRG-GU005, except for bladder D0.03cc. The mean±SD (Gy) rectum D15%, D25%, and D30% were 51±5, 45±5, 42±4. The mean±SD (Gy) bladder D0.03cc, D30%, D50% were 79±4, 50±8, 38±10. At a median follow up time of 21.3 months (range 7.1-38.2), no patients have developed biochemical progression, local recurrence, distant progression, or death from prostate cancer. One patient died at 18 months from metastatic colorectal cancer, unrelated to prostate cancer treatment. Acute grade 1-2 GU toxicity occurred in 13 (65%) patients, and acute grade 1-2 GI toxicity occurred in 4 (20%) patients. No patients developed grade 3+ acute or late GU or GI toxicity. Two patients required temporary foley catheter for obstruction during RT, and both had IPSS >20 at baseline. The patient who refused ADT had a PSA bounce of magnitude 2.2 ng/mL at 14 months, PSA values declined without additional treatment. CONCLUSION A novel 28-fraction focal boosted IMRT treatment is feasible and has an acceptable early toxicity profile. Oncologic results are promising but require longer follow up.
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Affiliation(s)
- J M Hands
- The George Washington University School of Medicine and Health Sciences, Manhattan Beach, CA
| | - M Whalen
- Department of Urology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Haji-Momenian
- Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | | | | | - D Provenzano
- Biomedical Engineering, George Washington University School of Engineering and Applied Science, Washington, DC
| | - J E Bauman
- University of Arizona Division of Hematology-Oncology, Tucson, AZ
| | | | - H Aghdam
- Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - D Chen
- Division of Radiation Oncology, Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - S Goyal
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - M Ojong-Ntui
- The George Washington University, Washington, DC
| | - Y J Rao
- Radiation Oncology, George Washington University School of Medicine and Health Sciences, Washington, DC
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Frazier H, Farfaglia PG. Pandemic Fatigue: Burnout Among Nutrition and Dietetics Program Directors. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.08.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alves Olguin M, Senne-Duff B, Frazier H, Vallor A. Relationship Between Food Insecurity, Stress, and other Health Markers in College Students During COVID-19. J Acad Nutr Diet 2021. [DOI: 10.1016/j.jand.2021.06.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Aragon-Ching JB, Simmens SJ, Hendricks F, Andrawis R, Frazier H, Phillips M, Jarrett T, Patierno SR, Siegel RS. Updated analysis of a pilot study examining the role of circulating tumor cells (CTCs) in biochemical recurrence (BR) of prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.e15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aragon-Ching JB, Simmens SJ, Hendricks F, Andrawis R, Frazier H, Jarrett T, Patierno SR, Siegel RS. Role of circulating tumor cells (CTCs) in biochemical recurrence (BR) of prostate cancer. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
60 Background: CTCs have an established role in the prognosis of metastatic prostate cancer. Little data exists regarding the role of CTCs in BR of prostate cancer. The aim of this study was to determine whether there is a correlation between the number of CTCs in men with BR with varying prostate specific antigen (PSA) and PSA doubling time (PSADT) categories. Secondary endpoints looking at correlation of the CTCs with clinical or laboratory factors (Gleason scores, testosterone, hemoglobin, alkaline phosphatase, BMI, imaging results) will also be assessed. Methods: BR was defined as patients (pts) who have undergone primary treatment with prostatectomy or radiation or both, with rise to >/= 0.2 from a prior undetectable level for prior prostatectomy or > 2 mg/dl rise from post-nadir radiotherapy. The study was powered to detect a Pearson correlation of .46 with a sample size of 36. Eleven of planned accrual goal of 36 pts were enrolled from May to September 2010. PSADT was obtained and correlated with the CTC values, categorized as PSADT of < 3 months, 3-14.9 months and > 15 months. CTCs were evaluated in 7.5 mL of peripheral blood using the CTC CellSearch test. Results: The median age for 11 patients was 75 y/o (range: 57-91) with a median PSA of 1.6 ng/mL (range 0.2-6.5) and testosterone levels of 309 ng/dL (range: 31–471). Gleason scores were 8 (n=1), 7 (n=5), 6 (n=2), 5 (n=3). Prostatectomy was the primary treatment in 6 pts, radiotherapy in 5 pts and Cyberknife in 1 pt. Median hemoglobin was 12.43 g/dL, BMI was 26.79 and alkaline phosphatase was 69 IU/L. PSADT varied between 3 to 55 months. All pts accrued had 0 CTC levels. The latter result translates into a 95% confidence interval upper bound of approximately .27 for the proportion of patients in this population who have non-zero CTC levels. Conclusions: Prostate cancer pts with BR have negative blood CTCs and does not appear to correlate with PSA or PSADT. However, the limited number of patients precludes sufficient interpretation at this time and further accrual is ongoing. The absence of CTC levels in this patient population, if supported through further data collection, could emerge as an important unanticipated finding from this study. Supported by IRG-08-091-01 from ACS to GWU Cancer Institute. No significant financial relationships to disclose.
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Affiliation(s)
- J. B. Aragon-Ching
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - S. J. Simmens
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - F. Hendricks
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - R. Andrawis
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - H. Frazier
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - T. Jarrett
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - S. R. Patierno
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
| | - R. S. Siegel
- The George Washington University Medical Center, Washington, DC; The George Washington University, Washington, DC
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Kerman RH, Susskind B, Kerman D, Lam M, Gerolami K, Williams J, Kalish R, Campbell M, Katz S, Van Buren CT, Frazier H, Radovancevic B, Fife S, Kahan B. Comparison of PRA-STAT, sHLA-EIA, and anti-human globulin-panel reactive antibody to identify alloreactivity in pretransplantation sera of heart transplant recipients: correlation to rejection and posttransplantation coronary artery disease. J Heart Lung Transplant 1998; 17:789-94. [PMID: 9730428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Screening pretransplantation recipient sera for percent panel reactive antibodies (%PRA) by an anti-human globulin (AHG) assay may identify recipients who are at risk for graft rejection or development of posttransplantation coronary artery disease. However, the pretransplantation AHG-%PRA does not always correlate with the occurrence of graft rejection or coronary artery disease. METHODS We compared the predictive capacity of the AHG-%PRA with that of an enzyme-linked immunoassay (EIA)-based PRA assay that identifies immunoglobulin G bound to soluble human leukocyte antigen (sHLA) class I molecules from pooled platelets of 240 random donors (sHLA-EIA), and that of an EIA-based assay that detects immunoglobulin G anti-HLA class I antibodies bound to sHLA derived from individual HLA-typed cell cultures (PRA-STAT). The pretransplantation sera from 130 cardiac allograft recipients were comparatively tested and results evaluated. RESULTS Although AHG-%PRA- and sHLA-EIA-determined PRA results were comparable, neither assay discriminated potential recipients at risk for rejection or coronary artery disease. However, cardiac allograft recipients with pretransplantation PRA-STAT sera > 10% were at risk for (1) graft rejection (77% vs 56%, p < .05); (2) more rejections/recipient (1.9 vs 1.0, p < .02); (3) graft rejection within 30 days (92% vs 38%, p < .001); or (4) development of coronary artery disease (48% vs 23%, p < .05) than recipients with pretransplantation PRA-STAT sera < 10%. CONCLUSIONS PRA-STAT analysis of pretransplantation sera from potential cardiac allograft recipients may be more clinically informative about HLA alloimmunity and a better predictor of adverse clinical events than either AHG-%PRA- or sHLA-EIA-determined PRA.
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Affiliation(s)
- R H Kerman
- Department of Surgery, The University of Texas Medical School, Houston 77030, USA
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Abstract
Testis cancer affects 2-3 men per every 100,000 in the United States, making it the most common solid tumor of men in the 20-35-year-old age range. Since the average age of active duty military personnel is included in the age range of those at greatest risk for germ cell testis cancer, it is of pertinent clinical importance to physicians who treat these young patients. The National Naval Medical Center has been using cisplatin-based protocols since the time of their introduction. This study reviews the success of treating these patients and examines the treatment failures.
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Affiliation(s)
- P Kelty
- Department of Urology, National Naval Medical Center, Bethesda, Maryland 20889-5000, USA
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Smalling RW, Sweeney M, Lachterman B, Hess MJ, Morris R, Anderson HV, Heibig J, Li G, Willerson JT, Frazier H. Transvalvular left ventricular assistance in cardiogenic shock secondary to acute myocardial infarction. Evidence for recovery from near fatal myocardial stunning. J Am Coll Cardiol 1994; 23:637-44. [PMID: 8113546 DOI: 10.1016/0735-1097(94)90748-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The purpose of this study was to test the hypothesis that transvalvular left ventricular assistance would support the circulation in patients with cardiogenic shock secondary to acute myocardial infarction and allow recovery of function in patients with a reversibly damaged (stunned) left ventricle. BACKGROUND Cardiogenic shock occurs in 7.5% of patients presenting with acute myocardial infarction, resulting in survival of only 20%. Despite the use of aggressive interventional therapy in patients with shock secondary to anterior myocardial infarction, survival remains as low as 33%. METHODS We studied 11 patients with acute myocardial infarction and cardiogenic shock, as defined by a cardiac index < 2 liters/min per m2, pulmonary capillary wedge pressure > 18 mm Hg and systolic blood pressure < 90 mm Hg during positive inotropic therapy. Patients were 57 +/- 13 years old (mean +/- SD) and had a mean left ventricular ejection fraction of 25 +/- 11%, mean arterial pressure of 69 +/- 13 mm Hg and mean cardiac index of 1.6 +/- 0.4 liters/min per m2 on admission to the study. RESULTS During the 1st 24 h of left ventricular assistance, pulmonary capillary wedge pressure decreased from 26 +/- 4 to 16 +/- 4 mm Hg (p = 0.01), cardiac index increased from 1.6 +/- 0.4 to 2.4 +/- 0.4 liters/min per m2, and the dopamine hydrochloride dose decreased from 51 +/- 92 to 18 +/- 12 micrograms/kg body weight per min. In survivors, cardiac index improved to 3.2 +/- 0.5 liters/min per m2 (p = 0.01), and left ventricular ejection fraction improved to 34 +/- 5% (p < 0.05). The overall survival in the study group was 4 (36%) of 11 patients (95% confidence interval [CI] 8% to 65%), and 4 (66%) of 6 patients (95% CI 29% to 100%) with a Q wave anterior myocardial infarction survived. CONCLUSIONS Transvalvular left ventricular support during cardiogenic shock complicating acute myocardial infarction is feasible and results in significant hemodynamic and functional improvement.
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Affiliation(s)
- R W Smalling
- Department of Internal Medicine, University of Texas Medical School at Houston 77030
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Hargraves JL, Palmer RH, Zapka J, Nerenz D, Frazier H, Orav EJ, Warner C, Ingard J, Neisuler R. Using patient reports to measure health care system performance. Clin Perform Qual Health Care 1993; 1:208-13. [PMID: 10135637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
We developed a self-administered patient questionnaire that asks for data concerning the time to receive services (access to care), communication between providers (coordination of care), and follow up after tests and treatment (continuity of care). From these data, we construct rates of performance about the clinical management systems that support provision of these services. Rates of system performance are calculated for indicators using patients' responses to survey questions. These indicators add the number of patients reporting a problem of those patients who have encountered a particular clinical management system. Information derived from 3000 patient questionnaires is matched with data abstracted from health care medical records. The sensitivity and specificity of patient reports are being evaluated for all indicators classified as gold standards for medical records. Indicators considered gold standard items for patient reports are matched for agreement with any information contained in the medical record. Also, patient characteristics associated with accurate reporting is to be assessed using multivariate logistic regression models.
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Affiliation(s)
- J L Hargraves
- Center for Quality of Care Research and Education, Harvard School of Public Health, Boston, MA 02115
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Furman R, Dean C, Frazier H, Furman L. One hundred consecutive laparoscopic cholecystectomies performed in a rural hospital. Am Surg 1992; 58:55-60. [PMID: 1531401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Laparoscopic cholecystectomy has quickly become the treatment of choice by most surgeons for the treatment of gallstone disease. The authors reviewed their first 100 consecutive patients undergoing laparoscopic cholecystectomy at a rural hospital. Twenty-three patients had previous abdominal procedures. The open insufflation technique was used on all patients with previous abdominal operations, with the exception of those who had an appendectomy only. Operative cholangiography was performed routinely and successfully on all patients, with the exception of the first seven because of nonavailability of a cholangiocath. In 54 percent of the first two-thirds of these patients, the operation was completed in less than 1.5 hours. In contrast, 88 percent of the last one-third of the patients were operated on within the same time period. All but 9 of the 100 patients were discharged within 24 hours of their surgery. Laparoscopic cholecystectomy can be performed safely and routinely in the rural hospital setting with results similar to those expected in larger metropolitan centers.
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Affiliation(s)
- R Furman
- Department of Surgery, Watauga Hospital, Boone, North Carolina 28607
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Affiliation(s)
- W S Smith
- Department of Radiology, National Naval Medical Center, Bethesda, MD 20889-5000
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Abstract
Many nurses and nursing students live far from the closest campus or health care agency that can provide basic or continuing education. Videoteleconferencing is one way to bridge this distance. As videoteleconferencing technologies become available and cost effective, nurse educators must be knowledgeable about their use. The authors explain telecommunications technologies of videoteleconferencing, identify advantages and disadvantages, and discuss planning, implementation, and evaluation for offering a program by videoteleconference.
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Liotta D, Navia JA, Frazier H, Cooley DA. The International Council for Clinical Research on mechanical circulation. The univentricular TAH project. Life Support Syst 1985; 3:72-4. [PMID: 3990354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Valdivieso M, Cabanillas F, Keating M, Barkley HT, Murphy WK, Burgess MA, Frazier H, Chen T, Bodey GP. Effects of intensive induction chemotherapy for extensive-disease small cell bronchogenic carcinoma in protected environment-prophylactic antibiotic units. Am J Med 1984; 76:405-12. [PMID: 6322584 DOI: 10.1016/0002-9343(84)90658-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Fifty-five patients with extensive-disease small cell bronchogenic carcinoma received three courses of intensive, inpatient, remission induction chemotherapy in (25 patients) or out (30 patients) of protected environment-prophylactic antibiotic (PEPA) units. Chemotherapy consisted of ECHO induction (E = epipodophyllotoxin VP-16-213; C = cyclophosphamide; H = hydroxydaunorubicin; O = Oncovin) and PRIME maintenance (PR = procarbazine; I = ifosfamide; ME = methotrexate). All evaluable patients (22 in the protected environment group and 26 in the control group) had a complete (50 percent in the protected environment group and 54 percent in the control group) or partial (50 percent in the protected environment group and 46 percent in the control group) remission. Median response and survival durations for both treatment groups were similar. The median survival duration of patients with a complete remission favored the protected environment group (16.5 versus 12.67 months; p = 0.20). Two patients (one from each group) are alive and disease-free for more than four years. Myelosuppression was intense and more pronounced in the protected environment group (p less than or equal to 0.01). Infectious complications were less common in patients receiving intravenous prophylactic antibiotics and in those treated with intravenous antibiotics in PEPA units (p less than or equal to 0.04). There were no treatment-related deaths, although treatment might have contributed to the death of three patients in the protected environment group and four in the control group. The administration of intensive ECHO induction chemotherapy to patients with extensive small cell bronchogenic carcinoma produced a high complete remission rate, although there was no significant long-term survival advantage over a program of less intensity. The administration of intravenous prophylactic antibiotics and the use of PEPA units significantly reduced the infectious morbidity of chemotherapy.
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Schmitt R, Capo T, Frazier H, Boren D. Cranial electrotherapy stimulation treatment of cognitive brain dysfunction in chemical dependence. J Clin Psychiatry 1984; 45:60-1, 62-3. [PMID: 6363398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Several studies have shown that cranial electrotherapy stimulation (CES) is useful in treating brain dysfunction associated with alcoholism. A double-blind study replicated the latest of these findings in 60 inpatients and extended them by treating individuals with alcoholism and other chemical dependencies. Treatment effects were assessed on three subscales of the WAIS that are clinical indicators of organic brain syndrome. No placebo effect was found. CES appears to be a valuable adjunct to rehabilitation programs for addicted persons and can effect changes in areas not addressed by other treatment modalities.
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Abstract
Family therapy has traditionally centered on the nuclear family and thus has been typically oriented toward urban white middle-class families. A variety of modifications in therapeutic technique has evolved for work with the many modern families whose structure consists of a functional psychosocial family kinship. The authors have developed a formal theoretical framework and model for family therapy that encompasses the total psychosocial network, i.e., the extended kinships of the nuclear family and the functional kin such as friends, neighbors, and associates.
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