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101.
Riaz SP Lüchtenborg M Jack RH Coupland VH Linklater KM Peake MD Møller H 《European journal of cancer (Oxford, England : 1990)》2012,48(1):54-60
Background
Compared with some European countries, England has low lung cancer survival and low use of surgical resection for lung cancer. The use of surgical resection varies within England. We assessed the relationship between surgical resection rate and the survival of lung cancer patients in England.Methods
We extracted data on 77,349 non-small cell lung cancer (NSCLC) patients diagnosed between 2004 and 2006 from the English National Cancer Repository Dataset. We calculated the frequency of surgical resection by age, socio-economic deprivation and geographical area. We used Cox regression to compute mortality hazard ratios according to quintiles of frequency of surgical resection amongst all 77,349 lung cancer patients, and separately for the 6900 patients who underwent surgical resection.Results
We found large geographical variation in the surgical resection rate for NSCLC in PCT areas (3-18%). A high frequency of resection was strongly inversely associated with overall mortality (HR 0.88, 95% CI 0.86-0.91 for the highest compared to the lowest resection quintile) and only moderately associated with mortality amongst the resected patients (HR 1.15, 95% CI 0.98-1.36). Compared to the highest resection quintile, 5420 deaths could be delayed in the overall NSCLC group, whereas about 146 more deaths could be expected amongst the resected patients.Conclusion
The differences in the magnitudes of both the hazard ratios and the absolute excess deaths within resected patients and all NSCLC patients suggests that lung cancer survival in England could plausibly increase if a larger proportion of patients underwent surgical resection. Carefully designed research into the possible benefit of increasing resection rates is indicated. 相似文献102.
103.
104.
Counselees who are the first in their family to request breast cancer genetic counselling often don’t know what to expect
or have unrealistic expectations of genetic counselling. Receiving tailored information might help them to prepare for their
first visit. We conducted a study of the effects of a pre-visit website providing computer-tailored information (E-info geneca), on counselees’ expectations, knowledge about breast cancer and heredity and information needs. Counselees were randomized
to receive usual care (UC) or UC plus website. All counselees completed a baseline questionnaire and those randomized to the
intervention group also completed a questionnaire after having viewed the website. After having accessed E-info geneca counselees (n = 101) better knew what to expect of their first visit (χ2 = 4.43; P = .04) and less often showed unrealistic expectations about possibilities for DNA-testing (χ2 = 4.84; P = .03) than counselees in the UC group (n = 89). In addition, the website increased counselees’ knowledge of breast cancer and heredity (B = .23; P = .003) and lowered their information needs (B = −.16; P = .000) compared to the UC group. Especially, information concerning procedural aspects and emotional consequences of genetic
counselling was considered less important. This study showed that counselees know more and need less when they are provided
with extended pre-visit information through a tailored website and counselees enter the visit with more realistic expectations
of genetic counselling. This might facilitate and focus communication within the subsequent consultation. 相似文献
105.
Introduction
Pre-visit education which helps counselees to prepare for their first visit for breast cancer genetic counseling might enhance information recall and needs fulfilment. This study assessed the effects of a pre-visit website with tailored information and question prompt sheet (QPS), named E-info geneca.Methods
A total of 197 counselees were randomized to receive usual care (UC) or UC plus E-info geneca. All counselees completed a pre- and post-visit questionnaire and visits were videotaped. We studied effects on counselees' information recall, knowledge about breast cancer and heredity, fulfillment of needs, risk perception alignment, anxiety and perceived personal control, using multilevel regression analyses.Results
Intent-to-treat analysis showed that counselees in the intervention group (n = 103) had higher levels of recall of information from the consultation (?? = .32; confidence interval (CI): .04 to .60; P = .02; d = .17) and post-visit knowledge of breast cancer and heredity (?? = .30; CI: .03 to .57; P = .03) than counselees in the UC group (n = 94). Also, intervention group counselees reported better fulfilment of information needs (?? = .31; CI: .03 to .60; P = .03). The effects of the intervention were strongest for those counselees who did not receive an indication for DNA testing. Their recall scores showed a larger increase (?? = .95; CI: .32 to 1.59; P = .003; d = .30) and their anxiety levels dropped more in the intervention compared to the UC group (?? = -.60; CI: -1.12 to -.09; P = .02). No intervention effects were found after the first visit on risk perception alignment or perceived personal control.Conclusions
This study shows that pre-counseling education, using tailored information technology, leads to more effective first visits for breast cancer genetic counseling, in particular for counselees who received no indication for DNA testing and, therefore, had no indication for a second visit. Future study should focus on the effects of a pre-visit website on the outcomes after a complete series of visits.Trial registration
Dutch Trial Register ISRCTN82643064. 相似文献106.
Forouzanfar T Sabelis A Ausems S Baart JA van der Waal I 《International journal of oral and maxillofacial surgery》2008,37(9):824-830
This study was designed to investigate the effect of compression with ice and compression alone on pain and quality of life after surgical removal of mandibular third molars. A prospective, single-blind, randomized controlled study design was chosen. Participants in group A applied 45 min of repeated compression with ice; those in group B applied 45 min of repeated compression without ice (control); and those in group C did not apply any compression. Pain intensity was measured on a visual analogue scale (VAS) three times a day for seven days. At day seven, overall pain reduction was scored on a global perceived effect (GPE) scale and a quality-of-life questionnaire was completed. Ninety-five patients completed the trial. The VAS scores demonstrated a significant pain decrease in groups A and B three days postoperatively. No significant differences were observed between groups A and B. Based on the GPE ratings, in groups A and B more patients indicated that pain was reduced successfully, but this was not statistically significant. Quality of life was significantly better for patients in groups A and B. These results demonstrate that compression after surgical removal of mandibular third molars is a valuable method for preventing pain. 相似文献
107.
108.
Hilde M van Keulen Ilse Mesters Johannes Brug Marlein Ausems Marci Campbell Ken Resnicow Paul J Zwietering Gerard van Breukelen Willem van Mechelen Johan L Severens Hein de Vries 《BMC public health》2008,8(1):1-18
Background
A large proportion of adults fail to meet public health guidelines for physical activity as well as fruit, vegetable and fat intake. Interventions are needed to improve these health behaviors. Both computer tailoring and motivational interviewing have shown themselves to be promising techniques for health behavior change. The Vitalum project aims to compare the efficacy of these techniques in improving the health behaviors of adults aged 45–70. This paper describes the design of the Vitalum study.Methods/Design
Dutch general medical practices (N = 23) were recruited via a registration network or by personal invitation. The participants were then enrolled through these general practices using an invitational letter. They (n = 2,881) received a written baseline questionnaire to assess health behaviors, and potential psychosocial and socio-demographic behavioral determinants. A power analysis indicated that 1,600 participants who were failing to meet the guidelines for physical activity and either fruit or vegetable consumption were needed. Eligible participants were stratified based on hypertension status and randomized into one of four intervention groups: tailored print communication, telephone motivational interviewing, combined, and control. The first two groups either received four letters or took part in four interviews, whereas the combined group received two letters and took part in two interviews in turns at 5, 13, 30 and 43 weeks after returning the baseline questionnaire. Each letter and interview focused on physical activity or nutrition behavior. The participants also took part in a telephone survey 25 weeks after baseline to gather new information for tailoring. There were two follow-up questionnaires, at 47 and 73 weeks after baseline, to measure short- and long-term effects. The control group received a tailored letter after the last posttest. The process, efficacy and cost-effectiveness of the interventions will be examined by means of multilevel mixed regression, cost-effectiveness analyses and process evaluation.Discussion
The Vitalum study simultaneously evaluates the efficacy of tailored print communication and telephone motivational interviewing, and their combined use for multiple behaviors and people with different motivational stages and education levels. The results can be used by policymakers to contribute to evidence-based prevention of chronic diseases.Trial Registration
Dutch Trial Register NTR1068 相似文献109.
I. A. P. Derks-Smeets T. C. van Tilborg A. van Montfoort L. Smits H. L. Torrance M. Meijer-Hoogeveen F. Broekmans J. C. F. M. Dreesen A. D. C. Paulussen V. C. G. Tjan-Heijnen I. Homminga M. M. J. van den Berg M. G. E. M. Ausems M. de Rycke C. E. M. de Die-Smulders W. Verpoest R. van Golde 《Journal of assisted reproduction and genetics》2017,34(11):1475-1482
Purpose
The aim of this study was to determine whether BRCA1/2 mutation carriers produce fewer mature oocytes after ovarian stimulation for in vitro fertilization (IVF) with preimplantation genetic diagnosis (PGD), in comparison to a PGD control group.Methods
A retrospective, international, multicenter cohort study was performed on data of first PGD cycles performed between January 2006 and September 2015. Data were extracted from medical files. The study was performed in one PGD center and three affiliated IVF centers in the Netherlands and one PGD center in Belgium. Exposed couples underwent PGD because of a pathogenic BRCA1/2 mutation, controls for other monogenic conditions. Only couples treated in a long gonadotropin-releasing hormone (GnRH) agonist-suppressive protocol, stimulated with at least 150 IU follicle stimulating hormone (FSH), were included. Women suspected to have a diminished ovarian reserve status due to chemotherapy, auto-immune disorders, or genetic conditions (other than BRCA1/2 mutations) were excluded. A total of 106 BRCA1/2 mutation carriers underwent PGD in this period, of which 43 (20 BRCA1 and 23 BRCA2 mutation carriers) met the inclusion criteria. They were compared to 174 controls selected by frequency matching.Results
Thirty-eight BRCA1/2 mutation carriers (18 BRCA1 and 20 BRCA2 mutation carriers) and 154 controls proceeded to oocyte pickup. The median number of mature oocytes was 7.0 (interquartile range (IQR) 4.0–9.0) in the BRCA group as a whole, 6.5 (IQR 4.0–8.0) in BRCA1 mutation carriers, 7.5 (IQR 5.5–9.0) in BRCA2 mutation carriers, and 8.0 (IQR 6.0–11.0) in controls. Multiple linear regression analysis with the number of mature oocytes as a dependent variable and adjustment for treatment center, female age, female body mass index (BMI), type of gonadotropin used, and the total dose of gonadotropins administered revealed a significantly lower yield of mature oocytes in the BRCA group as compared to controls (p = 0.04). This finding could be fully accounted for by the BRCA1 subgroup (BRCA1 mutation carriers versus controls p = 0.02, BRCA2 mutation carriers versus controls p = 0.50).Conclusions
Ovarian response to stimulation, expressed as the number of mature oocytes, was reduced in BRCA1 but not in BRCA2 mutation carriers. Although oocyte yield was in correspondence to a normal response in all subgroups, this finding points to a possible negative influence of the BRCA1 gene on ovarian reserve.110.