Changing thresholds and incidence of antibiotic treatment of cystic fibrosis pulmonary exacerbations, 1995–2005

BackgroundIncreased chronic therapy use and improved cystic fibrosis (CF) patient health should be accompanied by reduced pulmonary exacerbation-associated antibiotic treatment incidence.MethodsTreatment incidence rates and associated sign/symptom scores from 1995–2005 were studied in Epidemiologic Study of CF patients by route (± IV) and age (< 6, 6–12, 13–17, ≥ 18 years).ResultsOverall treatment incidence rate fell 0.0165 events/patient-year/year (P = .006); IV incidence fell 0.0179 (P < .001). Non-IV incidence increased in children ≤ 12 years (P ≤ .002) while significantly decreasing in older patients. Mean IV (P = .046) and non-IV (P = .004) treatment-associated clinical scores decreased in children < 6 years. Non-IV (but not IV) clinical scores decreased in older patients.ConclusionsIV incidence fell for all ages from 1995–2005; non-IV incidence increased in patients ≤ 12 years and fell in others. Average clinical treatment thresholds fell in children < 6 years; IV thresholds were unchanged in older patients; non-IV thresholds fell for patients ≥ 13 years. Decreases in treatment incidence were likely partially offset by lower treatment thresholds.     

Clients' Perceptions of Treatment for Depression: II. Problematic or Hindering Aspects

Clients' perceptions of the problematic or hindering aspects of treatment in the NIMH Treatment of Depression Collaborative Research Program were investigated, from the perspective of factors hypothesized to be common across treatments and those hypothesized to be specific to one type of treatment. Overall, 36% of the 154 treatment completers indicated that something was problematic for them about their treatment or about their participation in the research. It was primarily clients in the imipramine plus clinical management and placebo plus clinical management conditions who gave responses categorized as specific to the treatment they had received, which for imipramine clients consisted primarily of complaints related to medication side effects. In addition, a small subset of pharmacotherapy clients indicated that they wanted psychotherapy. There were no significant differences among treatment conditions in the report of problems categorized as aspects common across all the treatments, such as therapist techniques and personal qualities. However, the report of a problem coded as a common aspect identified a small group of clients (n = 15) whose treatment outcome was comparatively less favorable.     

Positive aspects of patients’ state: A measure for assessing outcome and predicting follow-up of treatment for depression

Abstract

Most psychotherapy outcome studies in the field of depression focus on changes in depressive symptoms and impairment of functioning. The present article reports on the General Life Functioning Scale (GLF), a measure of more positive aspects of a patient's experience, specifically the patient's sense of well-being and feeling that he or she can cope with problems that arise. The development of the GLF and psychometric data are presented, followed by outcome analyses and prediction of follow-up in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Although there were no significant outcome findings, the GLF at termination significantly predicted follow-up status, emphasizing the importance of considering the extent to which depressed patients make gains in positive aspects of experience.

Zusammenfassung

Positive Aspekte des Patientenzustandes: Ein Maß zur Einschätzung des Behandlungserfolges und zur Vorhersage von Befindlichkeiten von depressiven Patienten zum Katamnesezeitpunkt

Die meisten Psychotherapie-Ergebnisstudien zu Depression sind auf Veränderung von depressiven Symptomen und die Beeinträchtigung von Funktionsweisen ausgerichtet. Die vorliegende Untersuchung berichtet über die General Life Functioning Skala (GLF), einem Maß zu positiven Aspekten der Erfahrung eines Patienten, insbesondere dem Gefühl des Wohlergehens und dem Gefühl, aufkommende Probleme bewältigen zu können. Es wird über die Konstruktion der GLF berichtet und es werden psychometrische Daten dazu vorgelegt, gefolgt durch Ergebnisanalysen und Vorhersagen des Zustandes von Patienten zum Anamnesezeitpunkt im ‘National Institute of Mental Health Treatment of Depression Collaborative Research Program’. Obwohl es keine signifikanten Ergebnisdaten gab, sagte die zu Ende der Behandlungen erhobene GLF den Zustand zum Anamnesezeitpunkt signifikant vorher. Auf diese Art konnte die Wichtigkeit der Berücksichtigung des Ausmaßes, in dem depressive Patienten über das Ende der Behandlung hinaus weitere positive Erfahrungsgewinne verbuchen können, deutlich herausgestellt werden.

Résumé

Les aspects positifs de l’état du patient?: une mesure pour évaluer le résultat et prédire la catamnèse dans le traitement de la dépression

La plupart des études d'efficacité dans le domaine de la dépression focalisent sur les changements des symptômes dépressifs et l'handicap fonctionnel. Cet article parle de l'Echelle de Fonctionnement Général dans la Vie (GLF), une mesure d'aspects plus primitifs de l'expérience du patient, en particulier le sens de bien-être du patient et le sentiment qu'il arrive à gérer les problèmes qui surviennent. Nous présentons le développement et des données psychométriques de la GLF, ensuite des analyses d'efficacité et la prédiction de la catamnèse dans le Programme de Recherche en Collaboration de l'Institut National de Santé Mentale sur le Traitement de la Dépression. Malgré l'absence de résultats significatifs concernant l'efficacité, la GLF a prédit de façon significative à la fin du traitement l’état à la catamnèse, ce qui souligne l'importance de considérer la mesure dans laquelle des patients dépressifs font des progrès dans des aspects positifs de leur expérience.

Resumen

Aspectos positivos del estado de los pacientes: una medida para estimar el resultado y predecir el seguimiento en el tratamiento de la depresión

La mayoría de los estudios de resultado en psicoterapia de la depresión se centran en los cambios de los síntomas depresivos y de las dificultades de funcionamiento de estas personas. Este artículo informa sobre la Escala general del funcionamiento vital (GLF), una medida de los aspectos positivos de la experiencia del paciente, específicamente de su sensación de bienestar y del sentimiento de poder afrontar los problemas que le surgen. Se presenta el desarrollo de la GLF y los datos psicométricos, junto con análisis del resultado y la predicción del seguimiento en el Programa Colaborativo de Investigación de tratamiento de la depresión del Instituto Nacional de Salud Mental (Nacional Institute of Mental Health Treatment of Depression Collaborative Research Program. Si bien no se encontraron resultados significativos, la GLF aplicada al terminar predijo significativamente el estatuto del seguimiento, enfatizando la importancia de considerar el grado en que los pacientes depresivos mejoran en los aspectos positivos de su experiencia.

Resumo

Aspectos positivos do estado do paciente: Uma medida para avaliação dos resultados e predição do follow-up para o tratamento da depressão

A maioria dos estudos de resultados terapêuticos na área da depressão foca-se nas mudanças dos sintomas depressivos e do comprometimento do funcionamento. O presente artigo descreve a Escala de Funcionamento Geral de Vida (General Life Functioning Scale, GLF), uma medida dos aspectos mais positivos da experiência do paciente, especificamente o sentido de bem-estar do paciente e o sentimento de que pode lidar com os problemas que surjam. É apresentado o desenvolvimento da GLF, bem como os dados psicométricos, seguidos pelas análises de resultados e predição do seguimento (follow up) no Programa Colaborativo de Investigação do Tratamento da Depressão do National Institute of Mental Health (NIMH Treatment of Depression Collaborative Research Program). Apesar de não existirem resultados finais significativos, a GLF, no final da terapia, predisse significativamente o estado no seguimento (follow up), enfatizando a importância de considerar até que ponto os pacientes depressivos obtém ganhos nos aspectos positivos da experiência.

Sommario

Aspetti positivi dello stato dei pazienti: una misura per valutare i risultati e per aggiornare la predizione del trattamento per la depressione

La maggior parte degli studi di esito in psicoterapia nel campo della depressione si focalizzano sui cambiamenti dei sintomi depressivi e nelle disfunzioni del funzionamento. Il presente articolo presenta una relazione sulla scala di funzionamento di vita generale (GLF), una misura degli aspetti positivi dell'esperienza del paziente, specificamente sul senso di benessere del paziente e dei sentimenti che lui o lei possono fronteggiare con i problemi che si presentano.

Sono presentati gli sviluppi della GLF ed i dati psicometrici, seguiti dalle analisi di esito e dalle previsioni di follow-up del National Institute of Mental Health Treatment of Depression Collaborative Research Program. Sebbene non ci fossero risultati significativi di esito, la GLF ha predetto significativamente la condizione di follow-up, enfatizzando l'importanza di considerare il grado/il punto al quale i pazienti depressi dimostrano di acquistare esperienza negli aspetti positivi.

Abstract

     

Adherence to surveillance guidelines after radical cystectomy: A population-based analysis

ObjectivesSurveillance after radical cystectomy is recommended to detect tumor recurrence and treatment complications. We evaluated adherence to National Comprehensive Cancer Network (NCCN) guidelines using a large population-based database.Methods and materialsThe Surveillance, Epidemiology, and End Results–Medicare database was used to identify patients aged ≥66 years diagnosed with nonmetastatic bladder cancer who had undergone radical cystectomy between 2000 and 2007. Medicare claims information identified recommended surveillance tests for 2 years after cystectomy as outlined in the NCCN guidelines. Adherence was defined as receipt of urine cytology and imaging of the chest, abdomen, and pelvis in each year. We evaluated the effect of patient and provider characteristics on adherence, controlling for demographic and disease characteristics.ResultsOf 3,757 patients who had undergone radical cystectomy, 2,990 (80%) were alive after 2 years. Adherence to all recommended investigations was 17% for the first and the second years following surgery. Among patients surviving 2 years, only 9% had complete surveillance in both years. In either year, adherence was less likely in patients with advanced pathologic stage (III/IV) (adjusted odds ratio [AOR] = 0.74, 95% CI: 0.60–0.91) and unmarried patients (AOR = 0.82, 95% CI: 0.68–0.99). Adherence was more likely in patients treated by high-volume surgeons (AOR = 2.00, 95% CI: 1.70–2.36) and those who saw a medical oncologist (AOR = 1.52, 95% CI: 1.27–1.82). We also observed significant geographic variability in adherence.ConclusionPatterns of surveillance after radical cystectomy deviate considerably from NCCN recommendations. Despite increased utilization of radiographic imaging investigations, the omission of urine cytology significantly contributed to the low rate of overall adherence to surveillance guidelines. Uniform adherence to surveillance guidelines was observed in patients treated by high-volume surgeons. This suggests an important opportunity for quality improvement in bladder cancer care.     

Fluorescence in situ hybridization mapping of translocations and deletions involving the short arm of human chromosome 12 in malignant hematologic diseases

Translocations and deletions of the short arm of chromosome 12 [t(12p) and del(12p)] are common recurring abnormalities in a broad spectrum of hematologic malignant diseases. We studied 20 patients and one cell line whose cells contained 12p13 translocations and/or 12p deletions using fluorescence in situ hybridization (FISH) with phage, plasmid, and cosmid probes that we previously mapped and ordered on 12p12-13. FISH analysis showed that the 12p13 translocation breakpoints were clustered between two cosmids, D12S133 and D12S142, in 11 of 12 patients and in one cell line. FISH analysis of 11 patients with deletions demonstrated that the deletions were interstitial rather than terminal and that the distal part of 12p12, including the GDI-D4 gene and D12S54 marker, was deleted in all 11 patients. Moreover, FISH analysis showed that cells from 3 of these patients contained both a del(12p) and a 12p13 translocation and that the affected regions of these rearrangements appeared to overlap. We identified three yeast artificial chromosome (YAC) clones that span all the 12p13 translocation breakpoints mapped between D12S133 and D12S142. They have inserts of human DNA between 1.39 and 1.67 Mb. Because the region between D12S133 and D12S142 also represents the telomeric border of the smallest commonly deleted region of 12p, we also studied patients with a del(12p) using these YACs. The smallest YAC, 964c10, was deleted in 8 of 9 patients studied. In the other patient, the YAC labeled the del(12p) chromosome more weakly than the normal chromosome 12, suggesting that a part of the YAC was deleted. Thus, most 12p13 translocation breakpoints were clustered within the sequences contained in the 1.39 Mb YAC and this YAC appears to include the telomeric border of the smallest commonly deleted region. Whether the same gene is involved in both the translocations and deletions is presently unknown.     

癌症患者同伴支持量表的汉化及信效度检验

目的 汉化癌症患者同伴支持量表,并检验其信效度。方法 通过正译、回译、文化调试和预调查对原量表进行汉化,形成中文版癌症患者同伴支持量表。于2021年3月—6月选取长沙市2所三级甲等医院的128例青年癌症患者进行问卷调查,分析量表的信效度;2021年7月—2022年3月选取该2所医院招募的241例患者进行问卷调查,用于验证性因子分析。结果 中文版癌症患者同伴支持量表包括3个维度、11个条目。量表水平的内容效度指数为0.948,条目水平的内容效度指数为0.714～1.000。探索性因子分析提取出3个公因子,各条目因子载荷为0.535～0.872,累计方差贡献率为69.64%,方程拟合良好。量表总的Cronbach’s α系数为0.923,折半信度为0.860。验证性因子分析结果 显示,模型拟合度良好。结论 中文版癌症患者同伴支持量表的信效度良好,适用于青年癌症患者同伴支持感的评估。     

三维重建射频损伤区域观察猪舌根射频损伤体积与射频能量及时间的关系

目的：目前临床进行隧道法舌根射频治疗时,其作用参数的设置仍缺乏统一的标准,故通过计算机三维重建射频损伤区域,分析猪舌根射频损伤体积与射频能量、时间的关系,从中得出应用舌根隧道法射频治疗的最佳作用能级和作用时间。 方法：实验于2006-06/2007-05在上海交通大学耳鼻喉科研究所完成。将36只实验用猪以射频作用能级1,2,3,4,5,6随机分成6组,每组6头猪,各个猪舌的作用时间分别设置为2,5,10,15,20,25s。用Coblation射频发生仪及Reflex55刀头进行猪舌根射频操作。射频作用后的舌根组织行连续冰冻切片,苏木精-伊红染色后,进行序列组织切片的全貌二维图像采集,对拟重建的结构进行边界提取和图像分割。将提取分割图像导入Image-Pro Solution图像处理软件,利用3D Constructor插件进行三维重建,并根据设定参数进行体积计算。用SPSS10.0统计学软件对所测数据进行统计学分析。 结果：①作用能级固定时,舌根组织射频损伤体积随时间延长而增大,符合Logarithmic回归曲线。②作用时间固定时,舌根组织射频损伤体积随能级增大而增大,符合直线回归。③射频损伤体积随能量增大而增加亦符合Logarithmic回归曲线。④Coblation射频治疗系统在能级6时,在作用10s之前,损伤体积随作用时间增加而迅速增加,其后变化趋势平缓,超过20s后损伤体积无显著增加。 结论：①舌根区域射频治疗时,舌根组织射频损伤体积与时间或能量呈Logarithmic曲线相关,与能级呈直线相关。②Coblation射频治疗系统在能级6时,最佳作用时间范围为10-20s。