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Objectives Optimizing glycemic control in pediatric type 1 diabetes (T1D) is essential to minimizing long-term risk of complications. We used the T1D Exchange database from 58 US diabetes clinics to identify differences in diabetes management characteristics among children categorized as having excellent vs. poor glycemic control. Methods Among registry participants 6–17 yr old with diabetes duration ≥2 yr, those with excellent control [(A1c <7%)(53 mmol/mol) (N= 588)] were compared with those with poor control [(A1c ≥9%) (75 mmol/mol) (N = 2684)] using logistic regression. Results The excellent and poor control groups differed substantially in diabetes management (p < 0.001 for all) with more of the excellent control group using insulin pumps, performing blood glucose monitoring ≥5×/d, missing fewer boluses, bolusing before meals rather than at the time of or after a meal, using meal-specific insulin:carbohydrate ratios, checking their blood glucose prior to giving meal time insulin, giving insulin for daytime snacks, giving more bolus insulin, and using a lower mean total daily insulin dose than those in poor control. After adjusting for demographic and socioeconomic factors, diabetes management characteristics were still strongly associated with good vs. poor control. Notably, frequency of severe hypoglycemia was similar between the groups while DKA was more common in the poorly controlled group. Conclusions Children with excellent glycemic control tend to exhibit markedly different diabetes self-management techniques than those with poor control. This knowledge may further inform diabetes care providers and patients about specific characteristics and behaviors that can be augmented to potentially improve glycemic control.

Results: A total of 209 eligible patients were randomized with a median survival duration of 17.3 months for paclitaxel and 13.9 months for CMFP. Multivariate analysis showed that patients who received paclitaxel survived significantly longer than those who received CMFP (P ‫؍‬ .025). Paclitaxel produced significantly less severe leukopenia, thrombocytopenia, mucositis, documented infections (all P F .001), nausea or vomiting (P ‫؍‬ .003), and fever without documented infection (P ‫؍‬ .007), and less hospitalization for febrile neutropenia than did CMFP (P ‫؍‬ .001). Alopecia, peripheral neuropathy, and myalgia or arthralgia were more severe with paclitaxel (all P F .0001). Overall, quality of life was similar for both treatments (P H .07).Conclusion IN THE UNITED STATES each year, more than 180,000 women are diagnosed with breast cancer and more than 45,000 die of the disease. 1 Despite the major advances in adjuvant therapy, metastatic breast cancer remains a major clinical problem that affects large numbers of patients. For many years, standard chemotherapy combinations have been the mainstay of therapy for metastatic disease that is hormone resistant, estrogen receptor-negative, or with lifethreatening or visceral disease. Initial chemotherapy has been either combinations of cyclophosphamide, methotrexate, fluorouracil, and prednisone (CMFP) followed by anthracycline, or doxorubicin-containing combinations. [2][3][4] The choice of an appropriate initial chemotherapy is often limited by early relapse in patients who recently received adjuvant chemotherapy with the same combinations or by the condition of the patient. Thus, it is important to define the place of new anticancer drugs in breast cancer therapy.When first described by Cooper, 5 CMFP-like combinations were reported with high response rates. When assessed using modern criteria and increasingly sophisticated imaging procedures, the CMFP regimen with or without vincristine produced objective responses in 37% to 68% of patients and median durations of response ranging from 6 to 11 months, with an associated median survival duration from initiation of treatment of 7 to 16 months. [6][7][8][9][10][11][12][13][14][15] Doxorubicin alone has been shown to be as active as CMFP combinations in randomized studies in advanced breast cancer. 2,8,16 In these studies, doxorubicin produced shorter response duration when used as a single agent, but there was no clear difference in survival. Survival is difficult to interpret in these studies because patients were usually crossed over to the alternative regimen on progression.Of six randomized studies that compared combinations of cyclophosphamide, doxorubicin, and fluorouracil with CMFP combinations in advanced breast cancer, three showed significantly higher response rates with the combination of cyclophosphamide, doxorubicin, and fluorouracil. [17][18][19][20][21][22][23] However, only two of six studies showed a statistically significant survival advantage for the doxorubicin combination. These studies have bee...

Relapsed or refractory multiple myeloma has a poor outlook. Some patients respond to thalidomide; however, criteria for predicting response have not been conclusively identified. We initiated a prospective multicenter phase 2 trial in patients with relapsed/ refractory myeloma using thalidomide up to the maximum dose, 800 mg/d. Interferon-␣-2B (1.5-3.0 ؋ 10 6 U, subcutaneously, 3 times per week) was added at week 12 if disease was responsive or stable. Patients intolerant of interferon continued thalidomide alone. Thalidomide with or without interferon was continued until disease progression. Objectives were to determine toxicity, response rate (RR), progression-free survival (PFS), and overall survival (OS) and to elucidate relevant prognostic factors. We enrolled 75 patients, with median age 64 years (range, 36-83 years). Median individual maximum-tolerated dose of thalidomide was 600 mg/d; 41% reached 800 mg/d. Overall RR was 28%, and 55% stable disease (SD). The only predictor for response was age 65 years or younger (38% versus 17%; P ‫؍‬ .043). At 18 months median followup, the actuarial median PFS and OS were 5.5 and 14.6 months, respectively. Multivariate analysis for OS demonstrated age exceeding 65 years (median, 9.2 months versus longer than 26 months; P ‫؍‬ .011), raised serum lactate dehydrogenase (P ‫؍‬ .002), and raised serum creatinine (P ‫؍‬ .007) predicted inferior outcomes. Nineteen patients received interferon. Ten discontinued owing to toxicity. Four of 12 patients who received interferon for longer than 4 weeks were converted from SD to partial response. Our findings confirm substantial activity of thalidomide in relapsed/refractory myeloma. Interferon may improve response in selected patients, but is often not tolerated.

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This regimen was well tolerated, can be delivered as planned, and has resulted in excellent locoregional disease control and survival in patients with locally advanced nasopharyngeal cancer.

Oxytocin is the most common pharmacologic agent used for the induction and augmentation of labor. Oxytocin protocols can be divided into high-dose and low-dose protocols depending on the initial dose and the amount and rate of sequential increase in dose. Despite the frequency with which oxytocin in used in clinical practice, there is little consensus regarding which protocol is most appropriate. The purpose of this chapter is to review the most current data concerning recommendations for the use of oxytocin in the induction of labor, including cases of intrauterine fetal demise and vaginal birth after cesarean.

BACKGROUND. It is popular belief that the psychologic response to a diagnosis of cancer influences survival in patients with cancer; however, research has produced contradictory results. In this prospective study, the authors investigated the relation between pretreatment levels of optimism and survival in patients with nonsmall cell lung carcinoma (NSCLC). METHODS. Two hundred four patients who were participating in a randomized trial that compared accelerated and conventional radiotherapy with and without carboplatin chemotherapy were asked to complete two questionnaires assessing optimism. The first assessment was just prior to commencing treatment and the second assessment took place after completing treatment. Survival was measured from the date of randomization to the date of death. Surviving patients were followed until February 8, 2001. RESULTS. The pretreatment questionnaire was completed by 179 patients, and 148 of those patients completed the posttreatment questionnaire. There was a small but significant reduction in optimism scores after treatment (P ϭ 0.005). There was no association noted between pretreatment optimism and progression-free survival (P ϭ 0.52, unadjusted; P ϭ 0.22, adjusted for Eastern Cooperative Oncology Group performance status and patient age), nor was there an association noted between pretreatment optimism and overall survival (P ϭ 0.36, unadjusted; P ϭ 0.19, adjusted for disease stage). CONCLUSIONS. There was no evidence that a high level of optimism prior to treatment enhanced survival in patients with NSCLC. Encouraging patients to "be positive" only may add to the burden of having cancer while providing little benefit, at least in patients with NSCLC. Cancer 2004;100:1276-82.