IMPORTANCE Patients with oligometastatic non-small cell lung cancer (NSCLC) may benefit from locally ablative therapy (LAT) such as surgery or stereotactic radiotherapy. Prior studies were conducted before the advent of immunotherapy, and a strong biological rationale for the use of immunotherapy exists in a minimal residual disease state.OBJECTIVE To evaluate whether the addition of pembrolizumab after LAT improves outcomes for patients with oligometastatic NSCLC. DESIGN, SETTING, AND PARTICIPANTSThis single-arm phase 2 trial of pembrolizumab therapy was performed from February 1, 2015, through September 30, 2017, at an academic referral cancer center. The 51 eligible patients enrolled had oligometastatic NSCLC (Յ4 metastatic sites) and had completed LAT to all known sites of disease. Data were analyzed from February 1, 2015, to August 23, 2018.INTERVENTIONS Within 4 to 12 weeks of completing LAT, patients began intravenous pembrolizumab therapy, 200 mg every 21 days, for 8 cycles, with provision to continue to 16 cycles in the absence of progressive disease or untoward toxic effects. MAIN OUTCOMES AND MEASURESThe 2 primary efficacy end points were progression-free survival (PFS) from the start of LAT (PFS-L), which preceded enrollment in the trial, and PFS from the start of pembrolizumab therapy (PFS-P). The study was powered for comparison with historical data on the first efficacy end point. Secondary outcomes included overall survival, safety, and quality of life as measured by the Functional Assessment of Cancer Therapy-Lung instrument.RESULTS Of 51 patients enrolled, 45 (24 men [53%]; median age, 64 years [range, 46-82 years]) received pembrolizumab. At the time of analysis, 24 patients had progressive disease or had died. Median PFS-L was 19.1 months (95% CI, 9.4-28.7 months), significantly greater than the historical median of 6.6 months (P = .005). Median PFS-P was 18.7 months (95% CI, 10.1-27.1 months). Eleven patients died. Overall mean (SE) survival rate at 12 months was 90.9% (4.3%); at 24 months, 77.5% (6.7%). Neither programmed death ligand 1 expression nor CD8 T-cell tumor infiltration was associated with PFS-L. Pembrolizumab after LAT yielded no new safety signals and no reduction in quality of life.
To investigate climatic, spatial, temporal, and environmental patterns associated with hantavirus pulmonary syndrome (HPS) cases in the Four Corners region, we collected exposure site data for HPS cases that occurred in 1993 to 1995. Cases clustered seasonally and temporally by biome type and geographic location, and exposure sites were most often found in pinyon-juniper woodlands, grasslands, and Great Basin desert scrub lands, at elevations of 1,800 m to 2,500 m. Environmental factors (e.g., the dramatic increase in precipitation associated with the 1992 to 1993 El Niño) may indirectly increase the risk for Sin Nombre virus exposure and therefore may be of value in designing disease prevention campaigns.
Ms number: JHI-D-05-00521Discrepancy between self-reported and observed hand hygiene behaviour in health care professionals. Self reported and observed hand hygiene 3Professor Ben (C) Fletcher, November 2005. SummaryHand hygiene behaviour in 71 healthcare professionals was observed on hospital wards for a total of 132 hours and 1,284 hand hygiene opportunities. Questionnaires completed by the participants were used to compare actual behaviours with self-reports of behaviour, as well as intentions and attitudes towards hand hygiene. Observed practice showed very poor rates of adherence to guidelines and indicated that staff failed to take account of risk, even with patients colonised with MRSA. Observed practice was unrelated to carers" intentions and self-reports of behaviour. The results suggest that hand-hygiene interventions that target changes in attitudes, intentions or self-reported practice are likely to fail in terms of changing behaviour and consideration is given to how this could be remedied. (118 words) IntroductionThe U.K. Health Department guidelines state that hands should be washed "before and after contact with each patient" 1 . This study examines practitioners" adherence to this guideline, particularly taking note of practice when working with patients colonised with methicillinresistant Staphylococcus aureus (MRSA) patients. It also examines whether observed hand hygiene behaviour on wards is consistent with health professionals" self-reports of their actions.Research suggests that healthcare professionals clean their hands much less often than they say they do 2 . Understanding the link between self-reported and observed behaviours is of major importance in hand hygiene, but previous research has not concentrated on this. If there is no association, then interventions designed to improve intentions or self-reported MethodObservations were made on wards over a total period of 132 hours during which 1,284 opportunities for hand hygiene occurred. An opportunity for hand hygiene was defined as any occasion when a participant performed any activity which required hand hygiene, including contact with the patient, equipment, medication, food or prior to carers going on their break. Observations were made by two experienced observers: an infection control professional and a psychologist. Inter-rater reliability was established through both observers making the same observations for two days on four wards (kappa = 0.9, range 0.75-1.00).Seventy-one health care professionals (doctors, qualified nurses including "permanent" agency/bank nurses, therapists and healthcare assistants) were observed. In order to minimise effects of observational error, 51 of the health care professionals (72%) were observed on at least four occasions. Sampling of care activities and participants was Trust. All participants gave written consent prior to participating. ResultsThe percentage of opportunities when hands were washed both before and after contact with the patient, washing only before, or only after contact for di...
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