Is Internet-based support for dyspnea self-management in patients with chronic obstructive pulmonary disease possible? Results of a pilot study

BACKGROUND: As of 2003, approximately 67% of US adults have Internet access. The purpose of this study was to determine the feasibility and preliminary efficacy of an Internet-based dyspnea self-management program (iDSMP) for people with chronic obstructive pulmonary disease. A related aim was to compare the differential effects of the iDSMP on 2 different groups: (1) to test a "booster" effect and (2) to evaluate the program as a primary intervention. METHODS: Two groups (n = 16) were evaluated at baseline and at 3 months after completing the iDSMP, which included education, exercise, self-monitoring, and support. Dyspnea, self-efficacy, perception of available support, and exercise behavior were measured. Paired, independent t tests and Mann-Whitney U tests were used. RESULTS: Most subjects (87%) reported that the program increased their access to information and resources for managing dyspnea. Dyspnea with activities of daily living and self-efficacy for managing the symptom showed significant improvements (both P < .01), whereas more modest changes were noted in perceived support and exercise behavior in the overall sample. There were no differences between the 2 groups on these outcomes. CONCLUSIONS: The findings suggest that additional investigations of Internet-based interventions to promote self-management in patients with chronic obstructive pulmonary disease are warranted.     

Immunoscintigraphy with a new indium-111-labeled monoclonal antibody (MAb 1A3) in patients with colorectal cancer

PURPOSE: This study was designed to evaluate a new anticolorectal carcinoma monoclonal antibody (1A3), conjugated with the bifunctional chelating agent N,N′-bis (2-hydroxybenzyl) 1 (4-bromoacetamidobenzyl) 1,2-ethylenediamine-N,N′-diacetic acid and labeled with indium-111, in a Phase I/II study involving 38 patients with localized or advanced colorectal cancer. METHODS: Patients were injected with indium-111-N,N′-bis(2-hydroxybenzyl) 1 (4-bromoacetamidobenzyl) 1,2-ethylenediamine-N, N′-diacetic acid-monoclonal antibody 1A3 (1–50 mg, 1–5 mCi) and imaged at two or three sessions one to five days later. Scintigraphic findings were compared with radiologic, pathologic, surgical, and other clinical findings to assess the accuracy of radioimmunoscintigraphy. RESULTS: At least one known tumor site was clearly defined by planar scintigraphy in 29 (76 percent) patients. Increased radioactivity was seen in 40 of 63 known tumor sites (37/43 abdominal-pelvic, 3/15 hepatic, and 0/5 pulmonary sites) without any apparent dose-related effects. Nineteen previously undetected sites were considered positive by imaging, and, of these, six were biopsy-proven tumor sites, four were probable tumor sites, three were definitely false positive sites, and six were probable false positive sites. Radioimmunoscintigraphy detected proven tumor in 15 of 16 patients with negative or equivocal computed tomography results. Of the 28 patients with rectosigmoid cancer, 25 (89 percent) had positive studies with 34 of 47 tumor sites showing definite uptake on the scintigrams. This included 3 of 9 hepatic metastases. The only adverse reaction occurred in one patient who developed transient hives. Human anti-mouse antibody responses occurred in approximately one-half of the patients injected with doses of 10 or 50 mg. CONCLUSION: This study shows that radioimmunoscintigraphy with this indium-111-labeled monoclonal antibody is safe, it can detect most nonhepatic abdominalpelvic tumors with a positive predictive value of 83 (44/ 53) percent, and it should prove to be useful, particularly in the diagnosis of recurrent rectal carcinoma.     

Do Live Discharge Rates Increase as Hospices Approach Their Medicare Aggregate Payment Caps?

Context

The rate of live discharge from hospice and the proportion of hospices exceeding their aggregate caps have both increased for the last 15 years, becoming a source of federal scrutiny. The cap restricts aggregate payments hospices receive from Medicare during a 12-month period. The risk of repayment and the manner in which the cap is calculated may incentivize hospices coming close to their cap ceilings to discharge existing patients before the end of the cap year.

Increased DNA-incorporated thiopurine metabolite as a possible mechanism for leukocytopenia through cell apoptosis in inflammatory bowel disease patients with NUDT15 mutation

Journal of Gastroenterology - Polymorphisms in the nucleotide diphosphate-linked moiety X-type motif 15 (NUDT15) gene are associated with thiopurine-induced leukopenia in patients with inflammatory...