Ovarian cancer is the eighth most common cancer in women and is the fifth leading cause of cancer death, with an age-adjusted rate of 8.2 deaths per 100,000 women. Given current age-specific incidence and demographic projections, the number of cases of ovarian cancer will almost double over the next 35 years as women born between 1946 and 1964 (the baby boom generation) reach the age of highest incidence (60 years and older). While advances in surgery, chemotherapy, and radiation therapy over the past 20 years have led to improved outcomes, overall 5-year survival is only 42 percent for ovarian cancer compared with 88 percent for breast cancer and 63 percent for colorectal cancer. The high mortality rate in women with ovarian cancer is largely attributed to the later stage at presentation compared with other common cancers. This has led to intense research efforts to identify effective screening strategies for ovarian cancer, but results have been disappointing, particularly with regard to decreases in mortality. The objective of this report was to estimate the overall balance of harms and benefits from the potential use of oral contraceptives (OCs) for the primary prevention of ovarian cancer.

关键词：卵巢癌;口服避孕药;预防;风险;福利

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National HIV Testing Day, June 27, promotes the importance of testing in detecting, treating, and preventing human immunodeficiency virus (HIV) infection. HIV testing is the essential entry point to a continuum of prevention, health-care, and social services that improve the quality of life and the length of survival for persons with HIV (1). Persons with HIV who receive appropriate treatment, monitoring, and health care also reduce their chances of transmitting HIV to others. CDC recommends that all persons aged 1364 years be screened for HIV in health-care settings located in areas where the prevalence of undiagnosed HIV infection is >0.1, and that persons with increased risk for HIV be retested at least annually (2). In April 2013, the U.S. Preventive Services Task Force updated its 2005 guidelines on HIV screening, to recommend that clinicians screen all persons aged 1565 years for HIV infection at least once, regardless of their risk; that younger adolescents and older adults with increased risk also be screened; and that persons with increased risk be screened more frequently (3). These updated recommendations are based on increasing evidence of the benefits of early antiretroviral therapy for HIV-infected persons and its effectiveness in preventing HIV transmission.

关键词：获得性免疫缺陷综合征;艾滋病;艾滋病;传染病;人类;检测;评估

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This program is intended to establish the infrastructure to provide state-of-the art targeted radiation therapy to military personnel and veterans with cancer. The research aspect of this project is intended to demonstrate whether (1) targeted radiation therapy with real time localization and tracking will allow use of a smaller planning treatment volume margin with a significant decrease in rectal and bladder volume treated and whether the use of such targeted therapy can occur within standard treatment times and thus feasible for routine clinical use, (2) whether the use of Vac-Lok. immobilization devices are necessary when patients are treated using the Calypso system, (3) whether Beacon. Transponder is of benefit in pelvic radiation therapy following prostatectomy, (4) whether hypofractionated treatment plans which are more beam on time per fraction which may potentially account for more intra-fraction organ movement but allow for a shorter duration of treatment are feasible for routine clinical use with the Calypso system and (5) whether use of the Calypso system, and other advanced radiation therapy equipment, can improve treatment techniques and outcomes in malignancies arising in other parts of the body.

关键词：癌;放射治疗;膀胱;临床医学;患者

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Metastatic melanoma (common skin cancer) develops from malignant transformation of the melanocyte, a cell that produces the pigment melanin. Melanomas spread superficially or systemically by nodular invasion. Metastases spread to regional lymph nodes and then distally to the lungs, liver, bone, and brain, where they grow into large tumor masses. Melanoma, a cell type that is highly radiation-resistant, is treated by wide surgical excision of primary tumors. However, distal symptomatic metastases can only be treated by chemotherapy (dicarbazine, temozolomide, paclitaxel, or cisplatin), which produce low response rates to therapy (15), serious side-effects, and no improvement in overall survival. Current medical treatments are rarely successful, and the prognosis for patients diagnosed with metastatic melanoma is poor (Claveau et al., 2009). The need for improved and more effective therapies against metastatic melanoma is well-confirmed by recent clinical studies. Radiation biologists recognize that alpha particles are effective in killing melanoma cancer cells. High-linear-energy alpha particles can be effective in treating radiation-resistant disease that responds poorly to traditional low-linear-energy beta/gamma emitters (Sgouros et al., 2010). Because of the short range of alpha particles (40 to 70 micrometers in soft tissue), and to be effective in cell killing, the alpha-emitters need to be delivered directly to cancer cells using cell-targeted radioimmunotherapy.

关键词：黑素瘤;肽;肿瘤;细胞培养;化疗;诊断(医学)

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Over the course of the last year, the study team received IRB approval and began recruiting participants at five of the six study sites (Joint Base Lewis-McChord, Ft. Bliss, Ft. Campbell, Ft. Carson, and Ft. Stewart). As of August 31, 2012, 368 total referrals across the five active sites had been received; 179 participants had been enrolled and randomized into the study (86 participants into the STEPS UP arm; 93 participants into the optimized usual care arm); 53 participants completed the 3-month follow-up assessment; and 6 participants completed the 6-month follow-up. We are awaiting HRPO approval of our final site (Ft. Bragg); we anticipate beginning recruitment at Ft. Bragg in September 2012. Multiple amendments have been approved by the WRNMMC IRB, including an amendment that revised eligibility criteria and updated data collection forms. The study intervention has been refined to include a web-based care management support tool; nurse-assisted web- based cognitive-behavioral therapy options for PTSD and depression; a modularized telephonic cognitive-behavioral therapy option for PTSD and depression; and a preference-based stepped care approach to primary care PTSD and depression treatment sequencing. We have continued to hire and train site and centralized personnel.

关键词：创伤后应激障碍;随机变量;治疗;战争

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Ovarian cancer is the eighth most common cancer in women and is the fifth leading cause of cancer death, with an age-adjusted rate of 8.2 deaths per 100,000 women. Given current age-specific incidence and demographic projections, the number of cases of ovarian cancer will almost double over the next 35 years as women born between 1946 and 1964 (the baby boom generation) reach the age of highest incidence (60 years and older). While advances in surgery, chemotherapy, and radiation therapy over the past 20 years have led to improved outcomes, overall 5-year survival is only 42 percent for ovarian cancer compared with 88 percent for breast cancer and 63 percent for colorectal cancer. The high mortality rate in women with ovarian cancer is largely attributed to the later stage at presentation compared with other common cancers. This has led to intense research efforts to identify effective screening strategies for ovarian cancer, but results have been disappointing, particularly with regard to decreases in mortality. The objective of this report was to estimate the overall balance of harms and benefits from the potential use of oral contraceptives (OCs) for the primary prevention of ovarian cancer.

关键词：卵巢癌;口服避孕药;预防;风险;福利;死亡率

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Past Office of Inspector General work has shown that Medicare- and Medicaid-paid physical, occupational, and speech therapy services were vulnerable to improper payments because (1) plans of care were incomplete or missing; (2) documentation was missing, or providers failed to respond to our request for documentation; or (3) providers lacked proper qualifications, or we could not determine whether they had proper qualifications. We asked Medicaid staff from all States and the District of Columbia (States) to respond to a questionnaire requesting information about whether their States placed limits on therapy services, and if so, the nature of those limits. We examined paid Medicaid fee-for-service claims for therapy services in eight States (Arkansas, Florida, Hawaii, Illinois, Maine, Maryland, Michigan, and North Carolina) for the period July 1, 2008, through June 30, 2009, to determine whether the therapy services complied with State limits. We asked State Medicaid officials to describe the safeguards established to prevent payments in excess of State limits. We also asked State Medicaid staff to identify the reason(s) States safeguards failed to prevent payments in excess of State limits.

关键词：医疗补助;治疗服务;支付;不当支付州(美国);问卷调查;付款保障;建议

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The goal of this project is to engineer T-cells for adoptive cell therapy of prostate cancer, by conjugating drug-loaded nanoparticles to therapeutic cells to enable targeted drug delivery to tumor sites and lymph nodes. Nanoparticles with cytokine proteins bound to their surfaces will be attached to the surface of T-cells the equivalent of delivering a drug-loaded pill to each individual anti-tumor T-cell. These drug-carrying T-Pharmacytes will be continuously stimulated by the protein and carry these cytokine-loaded particles wherever they traffic in the body. We hypothesize that this strategy will provide a safe and effective means to augment adoptive cell therapy and allow the great promise of this immunotherapy to be realized for treatment of prostate cancer. The proposed studies will provide a preclinical test of this concept. If successful, this approach to enhancing an immunotherapy strategy already in clinical trials might be translated to patient treatment in a relatively short timespan.

关键词：临床医学;连续性;药;免疫治疗;淋巴结;测试与评估

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In 2011, Medicare paid about $5.7 billion to provide outpatient therapy services for 48 million beneficiaries.

关键词：手册;医疗保险;医疗费用;门诊服务;物理治疗

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Buprenorphine is an effective medication for the treatment of opioid dependence. Its use has increased in the United States as a result of the Drug Addiction Treatment Act of 2000, which allowed physicians to prescribe certain medications as part of office-based treatment for opioid addiction. In France, widespread use of medication-assisted therapy, primarily buprenorphine treatment, was associated with an 80decrease in overdose deaths from heroin or cocaine from 465 in 1996 to 89 in 2003 (1). With the expanded use of buprenorphine, an increase in exposures among children and adults has been reported in the United States. These exposures (including unintentional and intentional, therapeutic and nontherapeutic) have resulted in adverse effects and, in a small number of cases, death. To assess statewide increases in buprenorphine use and the number of reported exposures, the Utah Department of Health analyzed data from the Utah Controlled Substance Database (CSD) and the Utah Poison Control Center (PCC). The results of that analysis indicated a statewide increase in the annual number of patients prescribed buprenorphine from 22 in 2002 to 9,793 in 2011, and a concurrent increase in the annual number of prescribers writing buprenorphine prescriptions from 16 to 1,088. Over the same period, the number of exposures to buprenorphine reported annually to the PCC increased from six to 81. However, comparison of the ratios of buprenorphine exposures to patients and prescribers in 2002 with data for 2011 indicated substantial decreases from 6/22 for patients and 6/16 for prescribers in 2002 to 81/9,793 for patients and 81/1,088 for prescribers in 2011. Three of the total 462 buprenorphine exposures reported during 20022011 in Utah, in a teen and two adults, were associated with fatal outcomes. Increased buprenorphine prescribing in Utah during 20022011 likely represents expanded access to critically needed opioid addiction treatment; however, safeguards should be in place to prevent adverse effects. Prescribers and pharmacists are encouraged to counsel patients carefully regarding the safe use, storage, and disposal of buprenorphine.

关键词：处方药;药物治疗;接触;成年人;儿童;死亡;药物滥用,毒品

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