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81.
Cluster‐Randomized Trial of a Behavioral Intervention to Incorporate a Treat‐to‐Target Approach to Care of US Patients With Rheumatoid Arthritis
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Leslie R. Harrold Ani John Christine J. Barr Kevin Soe Robert Magner Katherine C. Saunders Eric M. Ruderman Tmirah Haselkorn Jeffrey D. Greenberg Allan Gibofsky J. Timothy Harrington Joel M. Kremer 《Arthritis care & research》2018,70(3):379-387
Objective
To assess the feasibility and efficacy of implementing a treat‐to‐target approach versus usual care in a US‐based cohort of rheumatoid arthritis patients.Methods
In this behavioral intervention trial, rheumatology practices were cluster‐randomized to provide treat‐to‐target care or usual care. Eligible patients with moderate/high disease activity (Clinical Disease Activity Index [CDAI] score >10) were followed for 12 months. Both treat‐to‐target and usual care patients were seen every 3 months. Treat‐to‐target providers were to have monthly visits with treatment acceleration at a minimum of every 3 months in patients with CDAI score >10; additional visits and treatment acceleration were at the discretion of usual care providers and patients. Coprimary end points were feasibility, assessed by rate of treatment acceleration conditional on CDAI score >10, and achievement of low disease activity (LDA; CDAI score ≤10) by an intent‐to‐treat analysis.Results
A total of 14 practice sites per study arm were included (246 patients receiving treat‐to‐target and 286 receiving usual care). The groups had similar baseline demographic and clinical characteristics. Rates of treatment acceleration (treat‐to‐target 47% versus usual care 50%; odds ratio [OR] 0.92 [95% confidence interval (95% CI) 0.64, 1.34]) and achievement of LDA (treat‐to‐target 57% versus usual care 55%; OR 1.05 [95% CI 0.60, 1.84]) were similar between groups. Treat‐to‐target providers reported patient reluctance and medication lag time as common barriers to treatment acceleration.Conclusion
This study is the first to examine the feasibility and efficacy of a treat‐to‐target approach in typical US rheumatology practice. Treat‐to‐target care was not associated with increased likelihood of treatment acceleration or achievement of LDA, and barriers to treatment acceleration were identified. 相似文献82.
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Anna-Kaisa Eerola Henni Ruokolainen Ylermi Soini Hannu Raunio Paavo PÄÄKKÖ 《Pathology oncology research : POR》1999,5(3):179-186
In order to test the hypothesis that increased apoptotic activity is connected with neuroendocrine differentiation and low
differentiation degree in large cell carcinoma (LCLC) and is regulated by bcl-2 family proteins, we analysed the extent of
apoptosis and tumor necrosis and their relation to the expression of bcl-2, bax, bak and mcl-1 in 35 LCLCs, of which 20 were
classified as large cell neuroendocrine lung carcinomas (LCNEC) and 15 as large cell non-neuroendocrine lung carcinomas (LCNNEC).
The extent of apoptosis was determined by detecting and counting the relative and absolute numbers of apoptotic cells and
bodies using in situ 3′-end labelling of the apoptotic DNA. The extent and intensity of expression of the bcl-2, bax, bak
and mcl-1 proteins were studied by immunohistochemistry. Also the relative volume density of necrosis was evaluated and correlated
with the other parameters. Finally, all the parameters were evaluated as prognostic markers and correlated with data on the
survival of the patients. Relatively high apoptotic indices were seen in both tumor types (average for both 2.53%, range 0.09–27.01%).
Significantly higher bcl-2 and bak indices were detected more often in LCNECs than in LCNNECs. Immunohistochemically detected
bax, bcl-2 and bak expression was independent of apoptotic index in both tumor types, while there was a statistically significant
positive association between mcl-1 expression and apoptotic index in LCNNEC but not in LCNEC. There was a statistically significant
association between high apoptotic index and shortened survival in LCLC. However, no association was found between tumor stage
and apoptosis. The patients with LCNEC and low bcl-2 protein expression had a significantly shorter survival time than those
with high bcl-2 indices. There was also a clear association between shortened survival and necrotic LCNNEC. LCLCs show relatively
high apoptotic activity, which is associated with shortened survival. The expression of bcl-2, bak and mcl-1 is associated
with neuroendocrine differentiation in LCLC. Finally, our results support some previous reports suggesting that bcl-2 expression
in combination with some other markers involved in apoptosis and/or proliferation may be of prognostic value in cases of lung
carcinoma with neuroendocrine differentiation. 179-186, 1999) 相似文献
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Background
Migrants from countries with a high-burden of tuberculosis (TB) are at a particular risk of contracting and developing the disease. In Sweden, new immigrants are routinely offered screening for the disease, yet very little is known about their beliefs about the disease which may affect healthcare-seeking behaviours. In this study we assessed recent immigrant students' knowledge of, and attitudes towards TB, and their relationship with the screening process. 相似文献88.
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DNA amplification by Polymerase Chain Reaction (PCR) of a repetitive sequence specific for Mycobacterium tuberculosis, from clinical samples of extra pulmonary origin were evaluated. The 123 base pair fragment of the insertion element IS 6110 in Mycobacterium tuberculosis was amplified. A total of 50 samples were analysed by PCR and compared with culture on Lowenstein-Jensen medium (LJ) and the clinical findings of the patient. Out of the total 26 samples were positive by PCR, while only seven grew the bacilli in culture. 24 samples were negative by PCR and culture. All the seven samples that grew the bacilli on culture were positive by PCR. In remaining 19 cases that were positive by PCR but did not grow the bacilli clinical features, radiological findings and Mantoux test were strongly suggestive of M. tuberculosis. All the amplification negative cases had no positive evidence of tuberculosis but were being followed up. When correlated with culture and clinical history the sensitivity of PCR for the diagnosis of active tuberculosis was 100%. However, the specifity was only 55.8% as culture on LJ (Gold Standard) was positive in only 7 samples out of 26 samples that were positive by PCR.KEY WORDS: DNA Amplification, IS 6110, Mycobacterium tuberculosis. 相似文献