Overall survival,costs, and healthcare resource use by line of therapy in Medicare patients with newly diagnosed metastatic urothelial carcinoma

Aims: Medicare patients with metastatic or surgically unresectable urothelial carcinoma (mUC) often receive platinum-based chemotherapy as first line of therapy (LOT), but invariably progress, requiring additional LOTs and healthcare resource use (HCRU). To better understand the evolving mUC treatment landscape, the economic burden of chemotherapy-based mUC treatments among US Medicare patients was estimated.

Methods: Newly diagnosed Medicare patients with mUC were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Patients were followed from diagnosis to death, disenrollment, or end of study to characterize LOTs (first [LOT1], second [LOT2], and third or greater [LOT3+]). Kaplan-Meier methods were used to estimate overall survival (OS) by LOT. HCRU and mean costs were reported over the follow-up period, LOT duration, and maximum LOT received.

Results: Among 1,873 eligible patients with mUC (median age?=?77?years; median follow-up?=?7.5?months), 1,035 (55%) received no chemotherapy. Among chemotherapy-treated patients, 61% had LOT1 only, 25% had LOT1 and LOT2 only, and 14% had LOT3+. Median OS was 8.1?months, range was 4.3 (untreated) to 29.8 (LOT3+) months. HCRU frequency increased with additional LOTs. Mean cumulative per-patient cost was $82,912 for all patients, increasing with additional LOTs (untreated?=?$57,207; LOT1?=?$99,213; LOT2?=?$125,190; LOT3+?=?$163,884). Mean per patient per month cost was $18,827 for all patients, decreasing with increasing number of LOTs received (untreated?=?$27,211; LOT1?=?$9,601; LOT2?=?$7,325; LOT3+?=?$6,017).

Limitations: Potential for treatment misclassification when using the algorithm defining LOTs and non-generalizability of results to younger patients.

Conclusions: Over 50% of Medicare patients with mUC received no chemotherapy. Among chemotherapy-treated patients, most received only one LOT. Additional LOTs led to higher mean costs and HCRU, but as patients were followed longer, monthly costs decreased. As treatments evolve to include immuno-oncology agents, these findings provide a clinically relevant economic benchmark for mUC treatment across different traditional LOTs.     

康复机器人研究进展

目前,康复机器人已经成为机器人领域的研究热点。详细介绍了康复机械手、医院机器人系统、智能轮椅、假肢及康复治疗机器人的国内外研究现状,并探讨了今后的发展方向。     

谈储备土地的前期开发整理工作

土地整治与开发等一系列前期开发工作,是执行土地年度供应计划,有计划地将储备的土地重新投入市场的前提,是土地储备交易部门的重要工作,更是进一步提高土地价值和出让收益、实现＂净地＂招拍挂出让土地、减少不必要矛盾至关重要的环节。因此,必须严格遵守土地前期开发整理的程序和原则,并做好前期开发整理的资金筹措。     

Real-world utilization of molecular diagnostic testing and matched drug therapies in the treatment of metastatic cancers

Aims: To assess the frequency of biopsies and molecular diagnostic testing (human DNA/RNA analysis), anti-cancer drug use (genomically-matched targeted therapy [GMTT], unmatched targeted therapy [UTT], endocrine therapy [ET], and chemotherapy [CT]), and medical service costs among adults with metastatic cancer.

Methods: Adults diagnosed with metastatic breast, non-small cell lung (NSCLC), colorectal, head and neck, ovarian, and uterine cancer (2010Q1–2015Q1) were identified in the OptumHealth Care Solutions claims database and followed from first metastatic diagnosis for ≥1 month and until the end of data availability. Utilization was assessed for each cancer cohort (all and patients aged ≥65 years); per-patient-per-month (PPPM) medical service costs were assessed for all patients. Testing frequency estimates were applied to Surveillance, Epidemiology, and End Results Program data to estimate the number of untested patients (2010–2014).

Results: Patients with metastatic cancer (n?=?8,193; breast [n?=?3,414], NSCLC [n?=?2,231], colorectal [n?=?1,611], head and neck [n?=?511], ovarian [n?=?275], and uterine [n?=?151]) were 63 years old (mean), with 11.1–22.2 months of observation. Biopsy and molecular diagnostic testing frequencies ranged from 7% (uterine) to 73% (ovarian), and from 34% (head and neck) to 52% (breast), respectively. Few were treated with GMTT (breast, 11%; NSCLC, 9%; colorectal, 6%). Treatment with UTT ranged from 0.7% (uterine) to 21% (colorectal). Biopsy, diagnostic testing, and anti-cancer drug therapy were less frequent for those ≥65 years. Medical service costs (PPPM, mean) ranged from $6,618 (head and neck) to $9,940 (ovarian). The estimated number of untested new patients with metastatic cancer was 636,369 (all) and 341,397 (≥65).

Limitations: In addition to the limitations of claims analyses, diagnostic testing frequency may be under-estimated if patients underwent testing prior to study inclusion.

Conclusions: The low frequency of molecular diagnostic testing suggests there are opportunities to better inform management of patients with advanced cancer, particularly decisions to treat with GMTT.     

大学生社交焦虑症的音乐治疗过程初探

文章探讨了音乐疗法对社交焦虑症患者的疗效。采用音乐疗法对一例存在社交焦虑症的求助者进行心理治疗,求助者4周后的各量表评分都达到了正常值,测验结果显示治疗达到了预期效果,得出音乐疗法对社交焦虑症具有一定的改善作用。     

Cost-effectiveness achieved through changing the composition of renal replacement therapy in Japan

Abstract

Objective:

The cost-effectiveness of renal replacement therapy (RRT) is affected by the composition of treatment. This study aimed to estimate the costs and outcomes associated with changing the composition of RRT modality over time.

Methods:

By using clinical and cost data from a systematic review, a Markov model was developed to assess the costs and benefits of the four main treatments available for RRT in Japan. The model included direct health service costs and quality-adjusted life years (QALY). Sensitivity analyses were performed to assess the robustness of the results.

Results:

Over the 15-year period of the model, the current composition of RRT (i.e., the base composition of RRT) was $84,008/QALY. The most cost-effective treatment was when the likelihood of a living donor transplant was increased by 2.4-times ($70,581/QALY). Compared with the base composition of RRT, dominant treatments with respect to cost-effectiveness were when the likelihood of a deceased donor transplant was increased by 22-times and when the likelihood of a pre-emptive living donor transplant was increased by 2.4-times. Little difference was found between these two treatments. One-way sensitivity analysis did not change the cost effectiveness except for costs of chronic hemodialysis and a living donor transplant in subsequent years.

Limitations:

It is difficult to increase the rate of transplant overall in the shorter term nationally and internationally.

Conclusions:

Appropriate distribution of all transplant options and hemodialysis is necessary to achieve the most cost-effective solution.     

阿奇霉素序贯疗法治疗小儿肺炎支原体肺炎临床疗效观察

目的探讨阿奇霉素序贯疗法治疗MPP的临床价值及优越性。方法将86例MPP患儿分为观察组（45例）和对照组（41例）,对照组给予红霉素静脉滴注治疗,观察组给予阿奇霉素序贯疗法治疗,观察两组患儿临床症状及体征改善情况,并进行疗效评定。结果观察组治疗总有效率为97.78%,明显高于对照组的82.93%（P＜0.05）;观察组临床症状和体征消失时间均低于对照组（P＜0.05）;观察组不良反应发生率为13.33%,明显低于对照组的34.15%（P＜0.05）。结论阿奇霉素序贯疗法治疗MPP具有疗效好、见效快、不良反应少等优点,是目前治疗小儿MPP的一种首选方案。     

Comparing technological hype cycles: Towards a theory

The notion of ‘hype’ is widely used and represents a tempting way to characterize developments in technological fields. The term appears in business as well as in academic domains. Consultancy firms offer technological hype cycle models to determine the state of development of technological fields in order to facilitate strategic investment decisions. In Science, Technology and Innovation Studies the concept of hype is considered in studies on the dynamics of expectations in innovation processes, which focuses on the performative force of expectations. What is still lacking is a theory of hype patterns that is able to explain the different shapes of hype cycles in different contexts. In this paper we take a first step towards closing this gap by studying and comparing the results of case studies on three hypes in three different empirical domains: voice over internet protocol (VoIP), gene therapy and high-temperature superconductivity. The cases differ in terms of the type of technology and the characteristics of the application environment. We conclude that hype patterns indeed vary a lot, and that the interplay of expectations at different levels affects the ability of a field to cope with hype and disappointment.     

货币政策的尴尬——浅析抑制通货膨胀中货币政策作用的弱化性及措施

中国发生的通货膨胀。虽然是在全球通胀的大环境下,但中国通胀有其独特的原因和历史背景。那么要抑制通胀,最简单的办法就是提高货币的价值,但是在目前的中国,这一问题就要复杂得多,我们多次运用紧缩的货币政策,并没有有效抑制通货膨胀,达到想象的预期效果,货币政策明显地表现出弱化性。所以目前"从紧"货币政策需要配合多种手段。解决的方案也不能局限在货币政策上。需要政府的宏观调控体制体现出更多的艺术和智慧。     

人本主义疗法在思想政治教育中的应用

思想政治教育是做人的工作,而要真正做好人的工作,就必须以人为中心,把握现代思想政治教育的特点和心理咨询、思想政治教育以及人本主义疗法三者的相互关联,使人本主义疗法在思想政治教育中发挥作用。