多种来源造血干细胞移植治疗重型再生障碍性贫血

背景：造血干细胞移植是年轻重型再生障碍性贫血患者首选方法,但在中国多数重型再生障碍性贫血患者无合适的供者,单倍体相合或非血缘造血干细胞移植国内外目前还处于探索阶段,联合间充质干细胞移植报道少见。 目的：观察不同干细胞来源造血干细胞移植治疗重型再生障碍性贫血的疗效。 方法：10例(3~52岁)重型再生障碍性贫血患者,分别接受了亲缘HLA相合(2例),单倍体相合(5例),非血缘(3例)的外周血和/或骨髓造血干细胞移植,其中5例患者同时联合了间充质干细胞共移植。预处理方案主要为环磷酰胺、氟达拉滨和抗人胸腺球蛋白,以霉酚酸酯、环孢素A加短疗程的甲氨蝶呤预防移植物抗宿主病,单倍体相合移植的患者在此基础上加马利兰和CD25单克隆抗体;同基因的例5患者预处理方案为抗人胸腺球蛋白+甲基泼尼龙。输注间充质干细胞的量为(0.27~1.85)×106/kg。接受和未接受间充质干细胞组的患者回输的造血干细胞有核细胞分别为(7.4~17.38)×108/kg和(6.09~13.68)×108/kg。 结果与结论：除1例单倍体相合患者移植未成功,+36 d死于并发症外,余患者移植后染色体及DNA指纹检测等说明造血干细胞移植完全供者植入。移植后中性粒细胞达到0.5×109 L-1,血小板计数≥20×109 L-1中位时间分别为12 d和13 d;其中造血功能恢复快慢的趋势是同基因移植>外周血或/和骨髓+间充质干细胞移植>单纯外周血或/和骨髓干细胞移植,而亲缘HLA全相合的52岁患者造血恢复最慢。非血缘移植例1、6患者发生了Ⅰ度急性移植物抗宿主病,单倍体相合移植的例2和例10患者发生了Ⅱ度急性移植物抗宿主病后出现了局限性的慢性移植物抗宿主病,余下患者移植后生活质量良好,无慢性移植物抗宿主病;除未接受间充质干细胞的例3患者移植后出现严重感染外,其余患者移植后再未出现严重的感染和出血。结果提示造血干细胞是安全,高效治疗重型再生障碍性贫血的方法,联合应用间充质造血干细胞者患者造血恢复快,移植并发症少。     

单倍体相合异基因造血干细胞移植治疗白血病

背景：对于无HLA全相合同胞供者的患者,采用单倍体相合造血干细胞移植面临移植物抗宿主病重、移植相关死亡率高的风险,但通过不同的移植模式,将有可能获取相近的疗效。 目的：观察亲缘HLA单倍体相合异基因造血干细胞移植治疗白血病的疗效,并与亲缘HLA全相合异基因造血干细胞移植相比较。 方法：45例白血病患者分为2组。单倍体组移植方式为外周血或联合骨髓干细胞移植,预处理方案为改良白消安与环磷酰胺或加抗胸腺细胞球蛋白,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤+霉酚酸脂;全相合组移植方式为外周血干细胞移植,预处理方案为BuCY,移植物抗宿主病的预防采用环孢素A+甲氨蝶呤。 结果与结论：两组均获得造血重建时间差异无显著性意义。单倍体及全相合组急性移植物抗宿主病的累积发病率分别为73%对52%(P > 0.05);慢性移植物抗宿主病的累积发病率分别为56%对45%(P > 0.05);移植相关死亡率分别为36%对17% (P > 0.05);单倍体组无复发,全相合组复发2例;两组的预计3年累积无病生存率分别为61%对60%(P > 0.05)。结果提示,亲缘单倍体异基因造血干细胞移植的总体疗效与亲缘全相合异基因造血干细胞移植相似,但中重度急性移植物抗宿主病的发生率较后者为高。     

造血干细胞移植与非移植治疗重型再生障碍性贫血的比较

背景：造血干细胞移植是公认的重型再生障碍性贫血最好的治疗办法。国内外已经开始进行了多种造血干细胞来源的移植,包括亲缘单倍体移植、非血缘移植,而联合间充质干细胞移植提高疗效的报道多为单独个案报道。 目的：回顾性对比分析造血干细胞移植与非移植治疗重型再生障碍性贫血的疗效。 方法：2008-04/2010-04住院的17例重型再生障碍性贫血患者,年龄3~53岁,8例患者接受造血干细胞移植,9例患者接受了非移植治疗。移植组的8例患者分别接受了亲缘HLA半相合(4例)、HLA相合(2例),非血缘(2例)的造血干细胞移植,在所有移植的患者中有4例在造血干细胞输注的同时静脉输注体外培养扩增的间充质造血干细胞。非移植治疗组9例患者主要采用免疫抑制剂和促造血治疗。 结果与结论：移植组除1例45岁患者接受过非移植方法治疗11个月无效,合并肾功能衰竭、肺部真菌感染时才行造血干细胞移植,死于移植合并症外,余7例患者移植后染色体及DNA指纹检测等说明造血干细胞移植完全供者植入,造血功能恢复快,中性粒细胞达到0.5×109 L-1,血小板计数≥20×109 L-1中位时间分别为12 d和14 d;其中接受间充质干细胞输注的4例患者平均中性粒细胞达到0.5×109 L-1,血小板计数≥20×109 L-1的中位时间均为11.6 d。移植患者发生Ⅰ,Ⅱ度急性移植物抗宿主病4例,局限慢性移植物抗宿主病者4例,移植后生活质量良好,无需血制品输注,无严重感染和出血。而非移植组患者治疗后造血功能均未恢复正常,1例死于脑出血和感染,余患者生活质量低下,需要反复住院对症治疗,长期间断的血制品输注;治疗后出现多种严重的合并症。结果表明造血干细胞移植是高效的治疗重型再生障碍性贫血的方法,患者造血恢复快,移植物抗宿主病可以预防和控制,生活质量高,疗效明显优于非移植治疗。     

HLA相合同胞异基因外周血造血干细胞移植治疗急性白血病

背景：HLA相合同胞间异基因外周血造血干细胞移植是治疗急性白血病的一种有效方法。 目的：评价HLA相合异基因外周血造血干细胞移植治疗急性白血病的临床疗效及并发症。 方法：25例急性白血病患者接受HLA相合同胞的异基因外周血造血干细胞移植,其中急性髓系白血病20例,急性淋巴细胞白血病5例。预处理方案为BU+CY方案或CY+TBI方案,移植物抗宿主病预防采用环孢素A+吗替麦考酚酯+短程甲氨蝶呤。 结果：最短随访2个月,最长随访80个月。患者均获造血重建,中性粒细胞≥0.5×109 L-1的时间为10~18 d,血小板≥20× 109 L-1的时间为10~37 d。主要并发症：感染败血症12例,巨细胞病毒感染9例,带状疱疹病毒感染3例,发生急性移植物抗宿主病10例,慢性移植物抗宿主病11例,出血性膀胱炎4例。至随访结束,17例无病生存,8例死亡。提示HLA相合同胞异基因外周血造血干细胞移植是治疗急性白血病安全有效的方法。     

HLA相合同胞供者异基因造血干细胞移植治疗慢性粒细胞白血病40例

背景：异基因造血干细胞移植仍是目前惟一能根治慢性粒细胞白血病的方法。随着移植技术的日臻完善,有HLA相合同胞供者的年轻慢性粒细胞白血病患者只需冒较小的近期风险,便可获得治愈疾病的远期疗效。 目的：回顾性分析HLA相合同胞供者异基因造血干细胞移植治疗慢性粒细胞白血病的疗效。 设计：回顾性病例分析。 对象：选择2002-02/2007-12在安徽省立医院血液科住院接受异基因造血干细胞移植的慢性粒细胞白血病患者40例,男29例,女11例,中位年龄35岁;慢性期30例,加速期5例,急变期5例。供者均为HLA6/6位点配型完全相合的同胞。 方法：根据移植方式进行分组：异基因骨髓移植组3例、异基因外周血干细胞移植组8例,联合组29例(异基因外周血干细胞移植+异基因骨髓移植)。预处理方案采用白消安+环磷酰胺或氟达拉滨+环磷酰胺+全身照射2 Gy。移植物抗宿主病预防方案为环孢素A+霉酚酸酯。随访中位时间为移植后28个月。 主要观察指标：造血功能恢复,移植相关并发症,复发及治疗转归,长期生存情况。 结果：40例患者均获造血重建。40例患者中,12例(30%)发生急性移植物抗宿主病,Ⅰ度5例(13%),Ⅱ度6例(15%),Ⅲ度1例(诱发)(3%)。可评估的存活100 d以上的39例患者中,15例(39%)出现慢性移植物抗宿主病。与联合组比较,异基因外周血干细胞移植组慢性移植物抗宿主病发生率明显升高(P < 0.05)。40例患者中,11例发生Ⅱ度~Ⅲ度迟发性出血性膀胱炎,无急性出血性膀胱炎和肝静脉闭塞病发生。长期无病生存率80%,其中慢性期30例长期无病生存率为87%,5例急变期患者长期无病生存率为20%。加速期5例患者使用伊马替尼达到2次慢性期后进行移植,至今全部无病生存。死亡8例,其中2例死于复发,5例死于移植相关并发症,自杀1例。 结论：HLA相合同胞供者异基因造血干细胞移植是治疗慢性粒细胞白血病的有效方法,尤其在慢性期移植效果较好。     

ABO血型不合异基因造血干细胞移植治疗恶性血液病★

背景：由于移植技术的提高,供受者ABO血型不合已不再是异基因造血干细胞移植的障碍，但是由于宿主血凝素抗体的持续存在,ABO血型不合异基因造血干细胞移植后常出现红细胞系统恢复的延迟。 目的：观察ABO血型不合异基因造血干细胞移植患者红细胞系统恢复情况,评价血型不合、人类白细胞抗原配型不相合对造血功能重建的影响。 设计：回顾性分析。　 单位：南京大学医学院附属鼓楼医院血液科。 对象：选择2002-05/2007-09在南京大学医学院附属鼓楼医院血液科行ABO血型不合异基因造血干细胞移植的恶性血液患者(受者)14例,男11例,女3例；年龄15~60岁。14例患者中7例供受者人类白细胞抗原配型完全相合,7例供受者人类白细胞抗原配型半相合。纳入同期ABO血型相合的造血干细胞移植患者11例为对照。受者在接受异基因造血干细胞移植前签署移植同意书，供者为同胞姊妹、胞弟、儿子、母亲，均同意提供用于移植的骨髓。实验经医院伦理委员会批准。 方法：①预处理方案：人类白细胞抗原配型全相合组采取马利兰和环磷酰胺为主的方案。人类白细胞抗原配型半不合组采用北京人民医院的GIAC方案。②造血干细胞输注：沉降供者骨髓,取上层有核细胞输给受者。 主要观察指标：观察ABO血型不合异基因造血干细胞移植的副反应、并发症及造血重建情况。 结果：14例ABO血型不合患者仅1例发生单纯红细胞再生障碍性贫血未进入结果分析。①造血功能重建情况：与对照组比较，ABO血型不合组血红蛋白恢复时间明显延迟(t=2.352, P < 0.05)，ABO血型相同与ABO血型不合组中性粒细胞和血小板恢复情况差异无显著性意义（P > 0.05）。ABO血型不合的人类白细胞抗原配型半不合造血干细胞组血红蛋白恢复和血型转换时间迟于全相合,但其差异无显著性意义（P > 0.05）。②并发症：14例ABO血型不合患者移植后成分输血过程未出现溶血反应,移植后也均未发生迟发性溶血反应。     

首次应用反转录病毒仅感染分裂细胞特性构建hTERT驱动野生型p53基因反转录病毒载体质粒***★

目的：研究表明ABO血型不合的异基因造血干细胞移植是安全的，但仍可能出现血液免疫学并发症。以同期ABO血型相合的受者作对照，分析ABO血型不合对异基因造血干细胞移植后红系重建的影响。 方法：①对象：选取解放军总医院1985-04/2006-04进行的异基因干细胞移植患者155例，ABO血型相合患者83例，ABO血型不合72例，包括主要不合32例，次要不合33例，主、次要双向不合7例。骨髓移植30例，外周血干细胞移植124例，骨髓+外周血干细胞移植1例。供受者对治疗均签署知情同意书，ABO血型相合与不合患者年龄、性别、原发病、疾病的缓解程度及预处理方案等基线资料差异均无显著性意义（P > 0.05）。②实验方法：行骨髓移植，ABO血型相合患者在全麻状态下采髓量1 010~1 430 mL，抗凝后当日回输；ABO血型主要和双向不合者用羟乙基淀粉沉降去除供者红细胞，次要不合者去除血浆，经静脉输注给受体。行外周血干细胞移植，供者使用重组人粒细胞集落刺激因子进行干细胞动员后，采集的干细胞悬液当日直接输注给患者。外周血中性粒细胞≥ 0.5×109 L-1时为植活时间；血红蛋白达100 g/L为红系恢复的标准；血小板恢复指血小板稳定于20×109 L-1以上。纯红细胞再生障碍性贫血的诊断标准是移植后网织红细胞数量< 1%的时间超过60 d，骨髓穿刺红系前体细胞缺失。③实验评估：分析细胞移植后造血重建、无病生存率及主要并发症发生率情况。 结果：①造血重建：细胞移植后，共4例发生纯红细胞再生障碍性贫血，其中ABO血型主要不合患者3例，双向不合患者1例。与ABO血型相合患者比较，ABO血型主要不合患者的粒细胞植活时间、血小板输注数量无明显变化（P > 0.05），红细胞输注量显著增加（P < 0.05），红系重建时间明显延长（P < 0.05）；ABO血型次要不合、双向不合患者上述4项指标的变化差异均无显著性意义（P > 0.05）。②无病生存率与主要并发症发生率：与ABO血型相合患者比较，ABO血型主要不合、次要不合、双向不合患者在细胞移植后1，3，5年的无病生存率均基本相似（P > 0.05）；急性移植物抗宿主病发生率、巨细胞病毒感染率均基本相似（P > 0.05）。 结论：ABO血型主要不合的异基因造血干细胞移植后可出现纯红细胞再生障碍性贫血，从而导致红系造血恢复迟缓及红细胞输注量增加，但对髓系和巨核系造血恢复无影响，与主要并发症的发生率和生存率无关。     

脂肪源性间充质干细胞联合造血干细胞共移植治疗顽固性重型再生障碍性贫血2例

选取2002-08/2007-12在河南省血液病研究所收治的2例顽固性重型再生障碍性贫血患儿,脂肪源性间充质干细胞分别来源于HLA半相合患儿母亲,外周血造血干细胞来源于HLA全相合的患儿同胞哥哥或妹妹。患儿1接受外周血造血干细胞与脂肪源性间充质干细胞(1×106/kg)共移植,输注的单个核细胞数4.5×108/kg,其中CD34+细胞和CD3+细胞分别为4.41×106/kg及0.11×105/kg;患儿2接受外周血造血干细胞与半相合脂肪源性间充质干细胞(1×106/kg)共移植,输注的单个核细胞数6.5×108/kg,其中CD34+细胞和CD3+细胞分别为4.62×106/kg及0.12×105/kg。结果两例患儿均移植成功,随访2年来患儿状态良好、未给予其他任何治疗,无输血依赖性。     

人脂肪源间充质干细胞治疗ABO血型不合造血干细胞移植后的顽固性单纯红细胞再生障碍性贫血2例

回顾性分析2004-04/2006-02河南省血液病研究所收治的2例接受异基因造血干细胞移植后并发单纯红细胞再生障碍性贫血的患者,病例1为一处于第2次完全缓解期的25岁女性急性淋巴细胞白血病患者;病例2为一处于第2次完全缓解状态的16岁女性急性髓细胞白血病患者。均经中心静脉输入脂肪源间充质干细胞进行治疗,剂量为1.0×106/kg。结果2例接受脂肪源间充质干细胞治疗的患者病情很快得以缓解,且均无明显不良反应出现。提示应用脂肪源间充质干细胞治疗ABO血型不合造血干细胞移植后出现的顽固性单纯红细胞再生障碍性贫血有一定的疗效。     

异基因造血干细胞移植治疗白血病9例

摘要：重庆医科大学附属第一医院血液内科2007-01/2008-04应用异基因造血干细胞移植治疗白血病患者9例,6例急性髓细胞性白血病,3例慢性髓系白血病;供者中6例为HLA 完全相合的同胞,2例为HLA 9/10相合的无关供者,1例为半相合供者;预处理采用经典的BU/CY方案或GIAC方案;移植物抗宿主病的预防采用环孢菌素A+吗替麦考酚酯+甲氨喋呤方案或环孢菌素A+吗替麦考酚酯+甲氨喋呤+抗胸腺细胞球蛋白方案。结果全部患者均获得造血重建,中性粒细胞≥ 0. 5×109 L-1、血小板> 20×109 L-1 的中位时间分别是11,15 d;无急性移植物抗宿主病发生,1例发生慢性移植物抗宿主病;随访3~16个月无病生存率为77.8%。死亡2例。 关键词：异基因造血干细胞移植;移植物抗宿主病;白血病     

焦虑症认知行为治疗与药物治疗对照研究

目的：比较认知行为治疗、抗焦虑药及二者结合治疗焦虑症的临床疗效、社会功能、生活满意度及生活质量改善情况。方法：焦虑症患者100例按随机区组法分为认知行为组、抗焦虑药物组、二者结合治疗组，疗程12周。分别于治疗前和治疗结束时采用汉密尔顿焦虑量表（HAMA）评定临床疗效，功能大体评定量表（GAF）、生活满意度量表（ISR）和生活质量综合评定问卷（GQOLI-74）评定患者的社会功能、生活满意度、生活质量情况。结果：治疗后，3组HAMA总分显著低于治疗前，社会功能、生活满意度和生活质量总分显著高于治疗前。认知行为组的不良反应显著低于药物治疗组和结合治疗组。结论：认知行为治疗、抗焦虑药和二者结合治疗焦虑症均有显著疗效，安全性好，结合治疗显示出一定的优势。3种治疗方法对患者的社会功能、生活满意度、生活质量均有明显改善。     

Australian Schizophrenia Care and Assessment Programme: real-world schizophrenia: economics

OBJECTIVE: The treatment of patients with schizophrenia consumes a considerable proportion of health service budgets, yet there have been few attempts to prospectively analyse the costs associated with this condition. Amid the current debate about where to invest scarce treatment resources to achieve optimal outcomes, real-world studies, such as the Schizophrenia Care and Assessment Programme (SCAP) contrast with hypothetically based models and provide comprehensive and broad-ranging data. METHOD: Direct health-care costs were prospectively studied in a cohort of 347 patients with schizophrenia in Dandenong, Australia over 3 years. Indirect costs were estimated from patient self-reported information. RESULTS: The average annual societal cost was AU $32,160 per participant in the first year of the study, AU $27,190 in the second year and AU $29,181 in the third year. Indirect costs accounted for 46% of the total costs in the first year, 52% of the total costs in the second year and 50% of the total costs in the third year. The most expensive component of treatment was inpatient hospital care, which accounted for 42%, 34% and 36% of the total costs in the first, second and third year, respectively. CONCLUSIONS: Considerable resources are required for the provision of treatment for patients with schizophrenia. But for the majority of people in this cohort, funding assertive treatment programmes and measures to reduce hospitalization was accompanied with enhanced functioning and quality of life, as well as a reduction in long-term societal and government costs. The distribution of health-care costs is highly skewed, with a relatively small proportion of patients (39%) consuming the majority of resources (80%). Improving rates of employment for this patient group could hold substantial benefits in reducing the overall economic and personal impact of this disorder.     

Costs of Remission and Recovery Using Family Therapy for Adolescent Anorexia Nervosa: A Descriptive Report

This paper reports on the costs of overall treatment for a cohort of adolescent patients with AN treated with a similar regimen consisting of inpatient medical stabilization, outpatient family therapy, and psychiatric medications for co-morbid psychiatric conditions. Most of the costs associated with outcome were secondary to medical hospitalization. However, the overall costs per remission varied widely depending on the threshold used. However, compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment.     

Costs of remission and recovery using family therapy for adolescent anorexia nervosa: a descriptive report

This paper reports on the costs of overall treatment for a cohort of adolescent patients with AN treated with a similar regimen consisting of inpatient medical stabilization, outpatient family therapy, and psychiatric medications for co-morbid psychiatric conditions. Most of the costs associated with outcome were secondary to medical hospitalization. However, the overall costs per remission varied widely depending on the threshold used. However, compared to costs described for adults with AN, adolescent treatment costs appear to be lower when families are used effectively to aid in treatment.     

Economic evaluation of spinal cord stimulation for chronic reflex sympathetic dystrophy

OBJECTIVE: To evaluate the economic aspects of treatment of chronic reflex sympathetic dystrophy (RSD) with spinal cord stimulation (SCS), using outcomes and costs of care before and after the start of treatment. METHODS: Fifty-four patients with chronic RSD were randomized to receive either SCS together with physical therapy (SCS+PT; n = 36) or physical therapy alone (PT; n = 18). Twenty-four SCS+PT patients responded positively to trial stimulation and underwent SCS implantation. During 12 months of follow-up, costs (routine RSD costs, SCS costs, out-of-pocket costs) and effects (pain relief by visual analogue scale, health-related quality of life [HRQL] improvement by EQ-5D) were assessed in both groups. Analyses were carried out up to 1 year and up to the expected time of death. RESULTS: SCS was both more effective and less costly than the standard treatment protocol. As a result of high initial costs of SCS, in the first year, the treatment per patient is $4,000 more than control therapy. However, in the lifetime analysis, SCS per patient is $60,000 cheaper than control therapy. In addition, at 12 months, SCS resulted in pain relief (SCS+PT [-2.7] vs PT [0.4] [p < 0.001]) and improved HRQL (SCS+PT [0.22] vs PT [0.03] [p = 0.004]). CONCLUSIONS: The authors found SCS to be both more effective and less expensive as compared with the standard treatment protocol for chronic RSD.     

The cost of multiple sclerosis in Australia.

Multiple sclerosis (MS) represents a significant economic burden both to the patient and to society. This study aims to provide information about direct and indirect costs of MS in Australia. Detailed questionnaires were completed for 100 patients over a 6-month period (12 months for hospitalization costs). Overall, the average annual direct and indirect costs per patient were AU$20 396 and AU$15 085, respectively. The greatest uses of resources were for immunomodulating drugs, consultations and district nursing. Various factors significantly increased overall direct costs, including secondary progressive MS, severe MS symptoms and higher Expanded Disability Status Scale scores. This study confirms that MS is a costly disease with a high economic burden on society. In order to minimize MS costs and improve quality of life, the ideal aim of MS treatment should be to stabilize patients on a low disability (low cost) level at an early stage of the disease utilising a cost-effective therapy.     

Costs of outpatient anticoagulant treatment in patients with cerebral and peripheral arterial occlusive disease

BACKGROUND AND OBJECTIVE: Knowledge of the costs of oral anticoagulant (AC) treatment may be relevant for resource allocation. Also, the incremental costs may be compared with other treatments for health care policy decisions. In this report, we have assessed actual costs of anticoagulant therapy in anticoagulation clinics (AC-clinic) in three different settings in the Netherlands. METHODS: Costs of anticoagulant drug supply and costs as a result of INR-adjustment procedures were estimated. We compared the total costs of treatment in patients treated after minor cerebral ischaemia in the Stroke Prevention in Reversible Ischemia Trial (SPIRIT) and in patients treated because of peripheral arterial occlusive disease in the Dutch Bypass Oral anticoagulants or Aspirin Trial (BOA). RESULTS: Costs of monitoring ranged between Euro 6.44 and Euro 9.87 per visit for monitoring at the AC-clinic and at home, respectively. The annual costs of administering anticoagulant drugs ranged between Euro 83 (phenprocoumon) and 107 (acenocoumarol). Variation in the overall actual annual costs of AC treatment was caused by the number of monitoring visits, the distribution of home and clinic visits and, to a lesser extent, the medication used. Annual costs of AC therapy for patients in SPIRIT was Euro 239 and for patients in BOA Euro 312. Overall costs of anticoagulant therapy were about 3 to 4-fold higher than standard treatment with aspirin. CONCLUSIONS: Although the actual costs of anticoagulant therapy may be substantially higher than that of other antithrombotic therapies, its cost-effectiveness depends highly on efficacy.     

Preliminary outcome study on assertive community treatment in Japan

Aims: The beneficial effects of assertive community treatment (ACT), which has been widely acclaimed as being successful in several foreign countries, must also be objectively evaluated with respect to the transition from inpatient to community‐based mental health treatment in Japan. This was the first study that examined effects of the ACT program in Japan using pre/post design data of the pilot trial of the ACT program in Japan project. Methods: The study included 41 subjects hospitalized at Kohnodai Hospital, National Center of Neurology and Psychiatry between May 2003 and April 2004 for severe mental illness and who met inclusion criteria for entry regarding age, diagnosis, residence, utilization of mental health services, social adjustment, and ability to function in daily activities. All subjects provided informed consent for study participation and were followed for 1 year after hospital discharge. Results: Comparison of the number of days and frequency of inpatient psychiatric hospitalization and frequency of emergency psychiatric visits between the 1‐year period before hospitalization and 1‐year period after hospital discharge showed a significant decrease in number of days and frequency of hospitalization. Comparison at 1 year after discharge with baseline showed no change in satisfaction with overall quality of life or Brief Psychiatric Rating Scale scores, but the Global Assessment of Functioning score significantly increased, and the antipsychotic dose (chlorpromazine equivalent) significantly decreased. Conclusion: Despite some limitations in methodology and conclusions, this study suggests that ACT enables persons with severe mental illness to live for longer periods in the community, without worsening of symptoms, decreased social function, or deterioration in quality of life.     

Treatment costs for glioblastoma multiforme in Nova Scotia

BACKGROUND: Glioblastoma Multiforme (GBM) is the most common and malignant brain tumor in adults. The median survival in patients harboring this neoplasm is 12 months irrespective of any form of therapy. Health care costs of illnesses with high mortality rates, such as GBM, are of particular interest in times of constrained health care resources. No information regarding costs for the treatment of patients with GBM is available in Canada. The aim of this study was to conduct an analysis of the costs of treatment of GBM in Nova Scotia. METHODS: Patients with histologically proven GBM during a three year period (1996-1998) in Nova Scotia were included in the study. Analysis was based on hospital costs supplemented by data on additional medical services received following discharge for the primary intervention. RESULTS: The mean cost of medical care per patient from the time of diagnosis to death was $17,149. The highest costs were related to hospitalization with ward costs alone accounting for 48% of all costs. Radiotherapy costs were 25%, surgery costs were 16% and chemotherapy costs were 7% of all costs. Costs for diagnostic procedures were 6% of the total costs. CONCLUSION: Our data reflect the costs and practice pattern in the treatment of GBM in Nova Scotia and may be of value as an initial attempt to analyze costs of treatment of GBM in Canada.