Neoadjuvant and concomitant chemotherapy and radiation therapy in patients with advanced head and neck carcinoma.

UNLABELLED: Our study evaluated the effectiveness of neoadjuvant chemotherapy and concomitant chemotherapy with radiotherapy compared to standard surgery and radiation therapy in patients with resectable stage III/IV head and neck squamous cell carcinoma. Forty-two eligible patients received neoadjuvant chemotherapy (cisplatin 100 mg/m2 intravenously day 1, and 5-fluorouracil 1 g/m2 /day continuous infusion days 1-5 every 3 weeks for 3 courses) followed by radiotherapy (65-70 Gy in 32-39 fractions to the primary site and lymph nodes; 50 Gy in 25-28 fractions to areas at risk) and concomitant chemotherapy (cisplatin 80 mg/m 2 intravenously every 3 weeks starting on day 1 of radiotherapy). Neoadjuvant therapy induced grade 4 cytopenias (12/42 patients) and grade 4 gastrointestinal toxicities (7/42 patients). Concomitant radiochemotherapy-induced grade 4 toxicities (6 patients). Neoadjuvant chemotherapy biopsy-proven complete responses were 15 of 42 patients (36%), partial responses in 23 of 42 patients (55%), and an overall response rate of 91%. Thirty-seven of 38 responders received concomitant radiochemotherapy. Complete responses in 35 of 42 patients (83%), partial response in 7 of 42 patients (7%), and overall response in 90%. The 3-year disease-free and overall survival for chemotherapy plus radiotherapy versus surgery plus radiotherapy: 61% versus 43% (P = 0.17) and 71% versus 43% (P = 0.02). These data suggest that a randomized trial of concomitant radiochemotherapy versus neoadjuvant plus concomitant radiochemotherapy should be considered. EBM RATING: B-2.

Relationship of professional involvement to clinical behaviors of physical therapists.

This study was designed to measure the level of professional involvement of respondents and to examine the relationship between a high level of professional involvement (eg, membership in the American Physical Therapy Association, attendance at Association conferences, participation in continuing education programs) and the frequency of use of high-complexity procedures. A questionnaire survey of 165 Alabama physical therapists was conducted to establish 1) the ranking of 24 physical therapy procedures according to the perceived level of complexity and 2) the relationship of a procedure's rank to delegation of that procedure to support personnel. The ranking and a cluster analysis of the 24 procedures correlated with similar ranking in other studies (Pearson r = .92). The level of complexity of a procedure influenced delegation to support personnel, with high-complexity procedures being delegated less frequently and requiring greater supervision than moderate- and low-complexity procedures. There was variation in the frequency of use of procedures, but a clear relationship was not found between a high level of professional involvement and use of high-complexity procedures. A relationship existed between professional involvement and both job title and types of referrals received. Those physical therapists with a higher level of professional involvement tended to be directors and supervisors (chi 2 = 28.29, df = 2, p less than .001), and they received autonomous referrals with greater frequency than those physical therapists with a lower level of involvement (chi 2 = 16.25, df = 3, p less than .001). The findings have implications for the continued professionalization of physical therapy and for the role that physical therapy educators and administrators play in this process.

Perceptual correlates of physician referral to physical therapists: implications for role expansion.

From an interprofessional role boundary maintenance perspective, this paper traces the historical development of physical therapy relative to physicians. Then, using survey data of 206 physicians in a metropolitan area of the United States, two hypotheses are tested regarding the prospects of physical therapy expanding its role to include highly autonomous skills. The first, from a set of structural-functionalist assumptions about role differentiation, posits that role expansion will precede status enhancement. The other, from conflict-theory assumptions about status politics, posits the opposite. A panel of physical therapists rated 24 procedures as requiring high, moderate and low skills. There was no significant difference in frequency of physician referral for the three levels; referral was associated with patient needs rather than physicians' perceptions of practitioner competency and status. The structural-functional hypothesis was supported, and two policy implications are noted: (1) an expanding physical therapy role is not likely to stimulate 'turf battles' with physicians, and (2) currently, greater professional autonomy is likely to be acquired by physical therapists making physicians aware of the extent of therapists' capabilities (role expansion), rather than through legislating more stringent curricular and license standards (status enhancement). The study is preliminary due to a small response rate.

Transition from student to physical therapist. Changes in perceptions of professional role and relationship between perceptions and job satisfaction.

A longitudinal study of 15 entry-level postbaccalaureate degree graduates was conducted to determine whether their perceptions of the professional role of the physical therapist and of self in that role changed after employment had begun and whether a relationship exists between these perceptions and job satisfaction. Data were collected by mail using a semantic differential test for measuring role perceptions and a questionnaire that included items related to job satisfaction and to demographic data. The return rate was 93%. At the time of data collection, the graduates had been employed for 12 to 18 months. The data on role perceptions were compared with data previously reported by Fincher Corb et al that had been collected on these same subjects when they entered the physical therapy education program and when they completed the program. Kendall's coefficient of concordance revealed significant differences (p less than .05) in three concepts relating to the professional role of the physical therapist and in one concept relating to self in that role. In each instance, the role perception score was lower after 12 to 18 months of employment. Job satisfaction scores were relatively high among the subjects. Spearman correlation coefficients calculated between job satisfaction and role perception scores revealed a positive and direct relationship between three role concepts and job satisfaction. Results of this study provide information about the professional socialization process in physical therapy.

Changes in students' perceptions of the professional role.

The purposes of this study were to determine whether students' perceptions of the role of the physical therapist and of themselves in that role change during a two-year entry-level postbaccalaureate degree program in physical therapy, when these changes occur, and the differences between students' perceptions and those of their faculty members. A semantic differential test was completed by 14 entry-level postbaccalaureate degree students five times during the two-year program. Sixteen faculty members completed the same test twice. Perceptions relating to five concepts of the professional role of the physical therapist and to five concepts relating to self in that role were assessed. Kendall's coefficient of concordance revealed no significant change in the students' perceptions of the role of the physical therapist, but it did reveal a significant change in one of the five concepts relating to their perceptions of themselves in that role (p less than .05). A Mann-Whitney U test revealed significant differences between the students' and faculty members' perceptions for 5 of the 10 concepts. Results of the study provide information about the professional socialization of physical therapy students.

Clinical experience and cognition of a physical therapy procedure.

This investigation was designed to determine if clinical experience influences cognition of a physical therapy procedure. We hypothesized that experience in the application of a physical therapy procedure on patients would increase the student's cognition of that procedure. Twenty-two junior students in a physical therapy baccalaureate program were study subjects. A multiple-choice test pertaining to gait training was administered to all subjects as a pretest and posttest. The pretest was given after classroom instruction and laboratory practice in gait training; posttest was administered eight weeks later. During the interim eight weeks, 11 subjects completed 32 hours of clinical experience and 11 subjects had no clinical experience. Analysis of the results of posttest compared with pretest indicated that for these subjects, clinical experience did not increase cognition of gait training.

Quantitative profiling analysis of organic acids in complex mixtures.

The simultaneous detection and quantitative determination of a very large number of metabolites in physiological fluids or tissues, and the subsequent comparison of these data with reference values, is a process which has commonly been called 'metabolic profiling' analysis. Profiles generated by gas-liquid chromatography on packed or capillary columns are readily analyzed by mass spectrometry, utilizing reverse library search procedures to identify individual components. Emphasis will be given here to procedures for the pre-purification of organic acids from plasma, to the use of quartz capillaries for metabolic profiling analysis, and to the sensitivity of this method for trace components.

High resolution gas chromatography mass spectrometry of the methyl esters of organic acids from uremic hemofiltrates.

The organic acid fraction of hemofiltrates was investigated in the form of methylates by glass capillary gas chromatography-mass spectrometry. The pattern obtained is similar to that of urinary organic acid methylates from healthy individuals. A marked difference was noted for N-phenylacetyl-alpha-aminoglutarimide, present in hemofiltrate at levels 50-100 times higher than those in urine. Analysis of hemofiltrate samples taken at different times during a hemofiltration with post-dilution technique revealed that the hemofiltrate concentration of most compounds was drastically reduced the course of the hemofiltration treatment. Compared to the other compounds, the reduction in hemofiltrate concentration of N-phenylacetyl-alpha-aminoglutarimide was extremely rapid.

Standards for Basic Education in Physical Therapy: a tool for planning clinical education.

Use of the Standards for Basic Education in Physical Therapy as the basis for organizing and implementing a program of clinical education is described. The article addresses the subject most specifically as it relates to the setting of an acute care general hospital; however, the program is described in sufficient detail to permit adaptation for other settings where personnel are participating in clinical teaching. Reasons for considering and developing this approach to clinical instruction are included, as well as preliminary subjective evaluation of the outcomes. The article is presented as a mechanism for exchange of ideas among persons engaged in clinical teaching.