tbuckley/cabot-search huggingface dataset:
Phase II study of pevonedistat (P) + azacitidine (A) versus A in patients (pts) with higher-risk myelodysplastic syndromes (MDS)/chronic myelomonocytic leukemia (CMML), or low-blast acute myelogenous leukemia (LB AML) (NCT02610777).
Authors: Lionel Ades, Justin M. Watts, Atanas Radinoff, Montserrat Arnan, Marco Cerrano, Patricia Font Lopez, Joshua F. Zeidner, Maria Diez-Campelo, Carlos Graux, Jane Liesveld, Dominik Selleslag, Nikolay Tzvetkov, Robert J. Fram, Dan Zhao, Douglas V. Faller, Mikkael A. Sekeres
Journal: Journal of Clinical Oncology (2020)

7506 Background: P, the first and only small-molecule inhibitor of the NEDD8-activating enzyme, disrupts proteasomal degradation of select proteins and has shown promising clinical activity and good tolerability in combination with A in AML. Methods: 120 pts with higher-risk (Revised International Prognostic Scoring System risk &gt; 3) MDS/CMML or LB AML naïve to hypomethylating agents were randomized 1:1 to receive P 20 mg/m 2 intravenously (IV) on days (d) 1, 3, 5 + A 75 mg/m 2 (IV/subcutaneously) on d 1–5, 8, 9 (n = 58), or A alone (n = 62), in 28-d cycles until unacceptable toxicity, relapse, transformation to AML, or progression. The primary endpoint was overall survival (OS), although the study was underpowered for OS. Results: Baseline characteristics were generally balanced between arms. Pts received a median of 13.0 vs 8.5 cycles of P+A vs A. Median OS in the intent-to-treat (ITT) population with P+A vs A (n = 120) was 21.8 vs 19.0 mos (hazard ratio [HR] 0.80; 95% CI 0.51–1.26; P = .334; median follow-up 21.4 vs 19.0 mos). Subanalyses showed median OS with P+A vs A in higher-risk MDS (n = 67) of 23.9 vs 19.1 mos (HR 0.70; 95% CI 0.39–1.27; P = .240) and in LB AML (n = 36) of 23.6 vs 16.0 mos; HR 0.49; 95% CI 0.22–1.11; P = .081). Event-free survival (EFS – time from randomization to death/transformation to AML) with P+A vs A trended longer in the ITT population (median 21.0 vs 16.6 mos; HR 0.65; 95% CI 0.41–1.02; P = .060) and was significantly longer in higher-risk MDS (median 20.2 vs 14.8 mos; HR 0.54; 95% CI 0.29–1.00; P = .045). In response-evaluable pts, overall response rate was 71% (n = 39/55; 46% complete remission [CR] + CR with incomplete blood count recovery [CRi], 5% partial response [PR], 20% hematologic improvement [HI]) with P+A vs 60% (n = 32/53; 38% CR+CRi, 8% PR, 15% HI) with A. In higher-risk MDS, CR rate was 52% vs 27% ( P = .050) with P+A vs A. Median A dose intensity was 97% vs 98% with P+A vs A. Rates of grade ≥3 adverse events were 90% vs 87% with P+A vs A; the most common were 31% vs 27% neutropenia, 26% vs 29% febrile neutropenia, 19% vs 27% anemia, and 19% vs 23% thrombocytopenia. On-study deaths occurred in 9% of P+A pts and 16% of A pts. Conclusions: P+A had a comparable safety profile to A alone, did not increase myelosuppression, and maintained A dose intensity. Although not statistically significant, P+A increased OS, EFS, and response rates vs A, particularly in pts with higher-risk MDS. Further evaluation of P+A vs A is ongoing in a randomized phase. Clinical trial information: NCT02610777 .
Prevalence &amp; pathogenic features of hereditary breast/ovarian cancer syndromes: Implementation of a genetic/familiar cancer risk assessment unit.
Authors: Jorge Ramón, Laura Rodriguez Rey, Luis Eduardo García, Darío Sánchez Cabrero, Oliver Higuera, Alejandro Gallego, Leticia Ruiz Gimenez, Nuria Rodriguez Salas
Journal: Journal of Clinical Oncology (2020)

e13645 Background: Currently studies found more than 25 genes associated with inherited Breast/Ovarian cancer. This syndrome shows morphologic, immunophenotic and molecular differences in comparison with sporadic ones. For example, BRCA1/2 are commonly ductal invasive carcinomas, with high grade of differentiation and high mitotic index, showing expression of basal o myoepithelial markers and overexpression of cell cycle proteins. Our study describe the outcomes since the implementation of Genetic/Familiar cancer risk assessment a tertiary hospital. Methods: A retrospective chart review was performed among all patients evaluated in Genetic counseling clinic in our hospital, since September 2008 to March 2019. Patients who fulfill criteria for Breast/Ovarian Cancer syndromes were included. We were specially interested in those with pathogenic, likely pathogenic or uncertain significance variants. All variants were named according to the practice of the BIC database, and the GenBank entries. Description on clinical features of tumor and frequency of implicated genes are considered for statistical analysis. All data were calculated in Stata IC 15. Results: 320 patients were eligible, 62,2% (n = 199) had cancer diagnosis. The most frequent tumor diagnosis was breast, 68,8% (n = 137), featured by: ductal carcinoma (82,5%), high grade differentiation (55,2%), triple negative (22,6%), local/locally advanced stage (86,13%) and bilateral component (16,1%). 11,6% had Breast cancer and 3,4% Ovarian cancer as second malignancies, respectively. Variant alterations were found in 24 different genes. BRCA 2 had the highest frequency (40,9%; n = 139 variants detected), BRCA 1 (24,7%; n = 84), ATM(7,4%; n = 25), PALB2(5,3%;n = 18) and BRIP1(2,9%, n = 10). 230 variants (68,3%) were pathogenic or likely pathogenic variants. Pathogenic mutation variant distribution in BRCA2 were c.3264dupT (n = 12); c.6275_6276delTT (n = 8); c.9026_9030delATCAT (n = 8). The most frequent mutations in BRCA1 were: c.1674delA (n = 7); c.302-1G &gt; A (n = 4); c.3331_3334delCAAG(n = 4). Among all patient with BRCA 1/2 mutations, 30,7% were undergone to prophylactic surgery, without statistical association with survival (p = 0,310). Conclusions: Our findings support literature about highly relation between BRCA1/2 and Breast/Ovarian Cancer. In our population, BRCA2 showed high frequency of pathogenic mutations. Patients with BRCA mutations and prophylactic mastectomy did not show statistical benefit in survival.
甲状腺功能亢进临床表现随增龄变化规律与诊断思维
Authors: 伍荣达
Journal: BMJ (2005)

对149例3～17岁、1 461例20～40岁、536例45～59岁和145例≥60岁甲状腺功能亢进者的主要症状体征发生率对比分析,以探讨甲状腺功能亢进主要临床表现随年龄变化的规律及这些表现对诊断的意义.研究证明甲状腺功能亢进一些特征性表现会随年龄增长趋于隐匿,年龄对甲亢的诊断和鉴别诊断有一定的意义。
偏头痛的肉毒毒素治疗
Authors: 万新华
Journal: BMJ (2007)

偏头痛是一种常见的慢性神经血管疾患,是普通门诊医师最常遇到的患者主诉之一.尽管有关偏头痛的药物及行为治疗已经取得一些重要进展,仍有部分患者存在对多种治疗的抵抗,可称之为顽固性偏头痛,成为临床工作中亟待解决的难题。
The multi-disciplinary meeting as a tool to identify patients for clinical trials and translational research.
Authors: H Winter, David Rea
Journal: Journal of Clinical Oncology (2020)

e14001 Background: Cancer multi-disciplinary team meetings (MDTs) were established with one of the core aims to increase participation in clinical research. However, a recent Cancer Research UK study observing 624 patient MDT discussions revealed only 8 (1.3%) patients included a discussion on clinical trials. Current work in the UK looking at MDT effectiveness has explored the quality of discussions and team dynamics. However, recruitment to clinical trials has not been promoted as an indicator of an effective MDT. This study explored the role of MDTs in identifying patients for research across all solid tumour MDTs in a tertiary cancer centre. Methods: This study explored the outcome data from solid tumour MDTS; reports on the observation of solid tumour MDTs and completion of a trials and translational proforma about patient discussions on research; exploration of MDT members views on the role of MDTS in identifying opportunities for patients to participate in clinical trials and translational research. Results: MDT outcomes from all solid tumour MDTs were reviewed. Out of 7000 local MDT outcomes from Avon Cancer Registry April 2019- Set 2019. Only 409 discussions included an outcome registered with “Clinical Trial y/n” (5%). In the majority there was no mention of any consideration of clinical trial or an explicit trial documented. Conclusions: We report on the exploration of the MDT as integral to identifying patients for clinical trials and translational research. This requires input and buy in from MDT members and the identification of research champions attending MDTs. The integration of genomics data into MDTs will require a proactive approach to access clinical trials for patients with identified potential actionable targets.
Discontinuation of tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia in chronic phase (CML-CP) in US clinical practice after guideline updates.
Authors: Ehab L. Atallah, Islam Sadek, Rodrigo O. Maegawa, Xiting Cao, Dominick Latremouille-Viau, Irina Pivneva, Carmine Rossi, Annie Guerin, Vamsi Kota
Journal: Journal of Clinical Oncology (2020)

7548 Background: NCCN CML practice guidelines were updated in 11/2016 and in 9/2019 to include considerations for discontinuation of TKI therapy in patients (pts) with CML-CP. This study characterized TKI discontinuation practices in the US after these updates and drew parallels with a similar study conducted prior to these guideline updates (Ritchie et al. Leuk Lymphoma. 2019). Methods: Pt charts of adult CML-CP pts with TKI discontinuation (1/2017-12/2018) outside a clinical trial after achieving an adequate response were abstracted (11/2019-12/2019) via an online case report form by US oncologists/hematologists. Physicians’ assessment of adequate response (TKI duration, molecular response [MR], MR duration) and relapse were described. Results: 61 physicians (academic: 43%; community-based practices: 57%) contributed 153 pt charts. Most physicians were from large practices (57%), had &gt; 10 years (y) experience since completing subspecialty training (59%), and treated a median of 30 CML pts in the last 2y; 56% did not have access to precise molecular response monitoring for BCR-ABL of ≥4.5 log when attempting TKI discontinuation. Pts with TKI discontinuation had mean age 56 years, were mostly male (60%), white (69%), and had TKI discontinued in first-line (96%). Most common reasons for TKI discontinuation were pt request (54%) and adverse events (18%), besides achieving an adequate response. Physicians’ assessment of adequate response for TKI discontinuation are reported in the Table. 21% of pts (academic: 12%; community: 30%) relapsed after TKI discontinuation (treatment-free remission [TFR] failure; 66% relapsed within 1y). Conclusions: Although NCCN CML practice guidelines provide guidance for discontinuation of TKI therapy, there remains heterogeneity in US practice and TKI discontinuation is predominantly attempted in first-line (similar to Ritchie et al. 2019). TKI discontinuation is being practiced without adequate sensitive tools mandated by practice guidelines to monitor response. Broader application of practice guidelines for optimal TKI therapy discontinuation in CML-CP pts is needed, particularly in community-based practices, to improve long-term TFR rates. [Table: see text]
Application status of aspirin for prevention of cardiovascular disease in Beijing community
Authors: Ying Zheng, Yuhong Liu, Haichuan Zhang, hui Yang
Journal: BMJ (2017)

入选2014年6—7月在广外社区中心5个社区卫生站连续就诊并患有高血压、糖尿病、脑卒中和冠心病4种慢性病或心血管疾病高危人群1 000例进行问卷调查。结果共回收855份有效问卷，显示一级预防组阿司匹林使用率为26.8%(127/474例)，二级预防组阿司匹林使用率为63.9%(207/324)，两组比较差异有统计学意义(P<0.05)。一级预防组中糖尿病患者伴有1项危险因素者阿司匹林使用率为22.3%例(31/139)，伴2项危险因素者使用率为38.2%(34/89)，伴3项以上危险因素者使用率为23.4%(11/47)。一级预防组中高血压患者伴有1项危险因素者阿司匹林使用率23.5%(56/238)，伴有2项危险因素者使用率为25.4%(35/138)。10年缺血性心血管病风险≥10%且合并3项以上危险因素者44例中仅有8例(18.2%)服用阿司匹林。提示，社区心血管疾病一级预防和二级预防人群中阿司匹林使用率较低，应该予以重视和改善。
Application of common clinical psychological rating scales in primary medical institutions
Authors: Yanling He
Journal: BMJ (2019)

随着双向转诊模式的开展，基层医疗机构已经开展了对精神疾病进行初步筛查以及对已确诊精神疾病患者在社区进行随访和管理。基于目前基层医疗机构在诊疗过程中对临床心理评估量表的应用存在的困扰和不规范，本文拟对量表的用途、如何选择量表、量表使用中需注意的问题，以及临床工作中常用的几类量表中的代表进行简要介绍，旨在加强全科医师临床心理评估量表的规范应用。
Cannabis use patterns and patient reported outcomes in oncology and hematology patients: An anonymous survey.
Authors: Shanmuga Subbiah, Cary A. Presant, Gargi Upadhyaya, Meizi Zheng
Journal: Journal of Clinical Oncology (2020)

e24143 Background: In a contemporary era of rapidly evolving social and regulatory changes, it is important to understand and characterize patient (pt) cannabis usage and response. Methods: In order to avoid responding bias, we performed the first ever anonymous survey in consecutive patients (pts) cared for in a City of Hope practice site in California. We analyzed demographic information, qualifying conditions, symptoms, and the cannabis product used. Pt reported outcomes of response to cannabis were collected. Improvement in control of symptoms was defined as pts choosing “total” or “a lot”. Results were tabulated and analyzed by the Chi-squared and Fisher’s Exact statistics. Results: 154 of 176 consecutive patients agreed to participate (87.5%). 72.7% had a malignancy (CA), 18.1% non-malignant hematologic disease (HEME), and 10.3% had other illnesses (OTHER). Age was &lt; 45 in 10.3%, 45-64 in 37.0%, and &gt; 64 in 52.6%. Older pts more frequently had CA (32.5% &lt; 45, 70.2% 45-64, vs 81.5% &gt; 64p = .0012). 41.8% were male. Cannabis use was reported in 24.7%. Surprisingly, this did not vary significantly by age (37.5% age &lt; 45, 28.0% age 45-64, and 19.8% age &gt; 64 p = .24), by disease (CA 22.9%, HEME 34.6%, OTHER 28.6% p = .41), nor by gender (male 21.9%, female 25.8% p = .57). Pts used cannabis to control their disease in 42.1%, GI symptoms (nausea, vomiting) in 28.9%, weight loss in 10.5%, fatigue in 42.1%, pain in 73.6%, and other symptoms in 36.8%. Cannabis product was marijuana (MJ) in 32%, CBD in 58% and THC in 8% and varied by age (p = .0006) but not by illness or gender. Improvement in disease was reported in 62.5%, GI symptoms in 63.6%, weight loss in 50%, fatigue in 50%, and pain in 60.7%. Symptom improvement trend was numerically higher with MJ or THC (71%) vs CBD (47%, p = .27). 73% of pts reported they would participate in a cannabis clinical trial. Conclusions: There is a high usage of cannabis. While cannabis use does not vary by age, preference for cannabis product however does vary by age. Pts reported high response rates for various symptoms, which can confound the effectiveness of anticancer or supportive medications. Clinical trials of anticancer agents should stratify by use of cannabis products to avoid misattribution of antitumor effects or side effects. Since cannabis access is expanding across the country, it provides an opportunity to perform randomized trials looking into benefits and risks of cannabis use, and dose and administration methods. Clinicians should screen for cannabis use and document it in social histories separate from the category of illegal drug use.
Reply to correspondence: “Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments”
Authors: Sara Manti, Amelia Licari, Salvatore Leonardi, Gian Luigi Marseglia, Eugenio Baraldi
Journal: Allergy (2020)

The authors have no conflicts of interest to disclose that could be perceived as prejudicing the impartiality of the research reported.
Clinical response and biomarker analysis of a phase II basket trial of toripalimab, a PD-1 mAb in combination with standard chemotherapy as a first-line treatment for patients with solid tumors.
Authors: Chao Ren, Xiao-Li Wei, Nong Xu, Lin Shen, Guanghai Dai, Xianglin Yuan, Ye Chen, Shujun Yang, Jianhua Shi, Xichun Hu, Xiaoyan Lin, Qingyuan Zhang, Jifeng Feng, Yi Ba, Yunpeng Liu, Wei Liu, Yongqian Shu, Rui-hua Xu
Journal: Journal of Clinical Oncology (2020)

e15083 Background: Platinum based chemotherapy is the standard care for 1 st line treatment of metastatic gastric adenocarcinoma (GC), esophageal squamous cell carcinoma (ESSC), nasopharyngeal carcinoma (NPC) and head and neck squamous cell carcinoma (HNSCC). Combinations of PD-1 blockade with chemotherapy have shown promising but mixed results in solid tumors. Predictive biomarkers for chemo-immunotherapy combination as 1 st line treatment remain undefined. Methods: Patients (n = 60) included in this analysis were four complete cohorts from a multi-center, phase Ib/II trial (NCT02915432) evaluating the safety and activity of toripalimab, a humanized PD-1 antibody in combination with standard chemotherapy for the 1 st line treatment of GC, EC, NPC and HNSCC (excluding NPC). Whole exome sequencing (WES), RNA sequencing and immunohistochemistry were performed on tumor biopsy samples. PD-L1 expression and tumor mutational burden (TMB) were evaluated for correlation with clinical efficacy. Results: From Oct 2016 to Feb 2019, 33 GC, 12 ESSC, 12 NPC and 3 HNSCC patients were enrolled and treated with 240mg or 360 mg toripalimab Q3W via IV infusion in combination with Oxaliplatin/Capecitabine (XELOX), Paclitaxel/Cisplatin (PP), Gemcitabine/Cisplatin (GP) and Docetaxel/Cisplatin/5-FU(TPF) respectively. By the data cutoff date of Nov 15, 2019, all patients experienced treatment related adverse event (TRAE). There was one TRAE (heart failure) leading to death. Grade 3-4 TRAEs occurred in 67% patients, mostly attributed to chemotherapy, including 27% neutropenia, 23% thrombocytopenia, 18% leukopenia and 12% anemia. As assessed by investigators according to RECIST v1.1, the ORR/DCR were 54.5%/84.8%, 66.7%/91.7%, 75.0%/83.3% and 33.3%/100% respectively for GC, EC, NPC and HSNCC cohorts. The median duration of response was 8.3, 6.8, 7.7 and 7.1 months respectively. WES showed distinctive patterns of genomic alterations among different cohorts. The clinical response was not correlated with either PD-L1 expression or tumor mutational burden. Conclusions: Toripalimab in combination with chemotherapy as first-line treatments showed promising results for metastatic GC, EC, NPC and HNSCC patients. Two randomized Phase III trials of toripalimab in combination with Paclitaxel/Cisplatin or Gemcitabine/Cisplatin versus chemotherapy alone are ongoing to further evaluate the combination as first-line treatments in metastatic EC and NPC patients. Clinical trial information: NCT02915432 .
Comparisons of survival time in BRCA-positive patients with metastatic breast cancer using electronic health records (EHRs).
Authors: Yookyung Christy Choi, Jerzy Edward Tyczynski, Dongmu Zhang
Journal: Journal of Clinical Oncology (2020)

e13004 Background: BRCA is a hereditary genetic mutation associated with a higher risk of breast cancer at younger age. Generally, BRCA gene testing is done in perceived high-risk individuals, and different management approaches might be considered given the high risk of breast cancer. This study examines treatment outcomes among BRCA-positive, metastatic breast cancer patients with consideration of prophylactic management by using US nationwide EHR data. Methods: This was a retrospective cohort study using Optum EHRs. The study cohort includes female adults who underwent their first systemic chemotherapy for metastatic breast cancer between 2013-2018 with a BRCA positive test result prior to the systemic chemotherapy, with ≥ 6 months baseline period from the chemotherapy. Physicians’ notes captured in Natural Language Processing (NLP) were further used to construct the cohort. Patients were followed from the earliest breast cancer diagnosis date until a censoring event (death or end of observation period). Death information was provided with national death certificate data. Descriptive statistics were used for patient characteristics and a stepwise Cox Proportional Hazard (CPH) regression model was fit to compare survival time. Results: Of 3624 patients included in the cohort, median age at the earliest breast cancer diagnosis is 50 years old (IQR 43-59), and a total of 540 (14.9%) deaths was observed. Prior to systemic chemotherapy, 1430 (39.5%) received mastectomy/lumpsectomy. 571 (15.8%) received hormone therapy prior to systemic chemotherapy. 646 (17.8%) had a clinical record indicating a triple negative breast cancer (TNBC). 2196 (60.6%) received more than 1 line of chemotherapy. Overall median survival days in the study cohort was 3778 days from the earliest breast cancer diagnosis. Median survival days in those with ER/PR positive and with TNBC status were 4150 days and 3124 days, respectively. From the CPH model, age, tumor mutation status, and prior mastectomy/lumpectomy were identified as significant factors; Hazard Ratio (HR) with each 1 year older in age at diagnosis was 1.02 (95% CL 1.01-1.03), that of TNBC vs ER/PR positive status was 2.27 (95% CL 1.87-2.77) and that of those with prior surgery vs without was 0.567 (95% CL 0.457-0.703). Conclusions: This study demonstrated the utility of EHR database for survival analysis. In metastatic breast cancer patients with a known BRCA-positive status, age at the initial diagnosis, tumor mutation status, and prior mastectomy/lumpectomy were significant factors in survival time.
Covid-19: Easing lockdown could risk second spike, say public health doctors
Authors: Adrian O’Dowd
Journal: BMJ (2020)

Public health experts have added their voice to growing calls for the government to reverse its decision to ease covid-19 lockdown restrictions in England that came into force on 1 June, saying that the change in policy was not “supported by the science” and could risk lives.

The Association of Directors of Public Health has issued blunt warnings that easing the restrictions could risk a spike in cases and deaths and that therefore the full implementation of what the government describes as its “phase 2” measures should be delayed.

From I June England is allowing groups of up to six people to meet outdoors, provided that strict social distancing guidelines are followed, encouraging more pupils to return to school, more businesses to reopen, and allowing vulnerable people to go outside once a day.

The Westminster government said the …
Proteus Infections in a General Hospital. I. Biochemical Characteristics and Antibiotic Susceptibility of the Organisms
Authors: Jonathan L. Adler, John P. Burke, Maxwell Finland
Journal: Annals of Internal Medicine (2020)

Abstract Biochemical characteristics, bacteriophage and bacteriocine typing, Dienes tests, and susceptibility to antibiotics were used to classify strains ofProteus mirabilisfrom 209 patients at Bo...
Medications during pregnancy and birth defect
Authors: 张琳, 程利南
Journal: BMJ (2007)

出生缺陷(birth defect)是指先天性的严重偏离正常形态和功能的一系列临床病变.美国出生缺陷率约为3%[1],而我国目前共有先天性畸形患者3000多万人,每年大约有100万左右缺陷婴儿出生[2].在20世纪60年代以前,胎盘被认为是一个天然的屏障,任何的毒性物质都不能通过胎盘影响胎儿。
Cost-effectiveness of integrated pharmaceutical care in community-based patients with chronic obstructive pulmonary disease
Authors: Zong-jun Fang, Zhen Li, Ming-jian Ge, Rong Yang, Ya Zhu
Journal: BMJ (2012)

Objective To analyze the cost-effectiveness of integrated pharmaceutical care (IPC) in community-based patients with chronic obstructive pulmonary disease (COPD).Methods The COPD patients were divided randomly into intervention group (group A,n =79) and control group (group B,n =71).Group A received the IPC intervention measures,including serial lectures of pharmaceutical knowledge,home supervision and web-based communications for while group B group had none.Results As compared with group B,group A obviously improved on the knowledge of pharmaceutical treatment effect and side effect (95.1％,67.4％ vs.63.1％,21.9％,x2 =12.445,P=0.000 vs.x2 =55.557,P=0.000).There were notable differences between two groups [ ( 1.77 ± 1.23 ) vs.( 2.42 ± 1.66 ) s,t =2.583,P=0.011],pulmonary rales [ (0.01 vs.0.01)s,Z =2.370,P=0.018],6-min walk distance (6 MWD) [ (457 ± 67 ) vs.(425 ± 72) m,t =2.760,P =0.007 ],vital capacity ( VC ) [ ( 1.60 ± 0.25 ) vs.( 1.49 ± 0.23 ) L,t =2.718,P =0.007 ) ] and quality-of-life items ( 48 ± 10 vs.52 ± 11,t =2.624,P =0.010) after intervention.Analyze of cost-effectiveness show that group A was superior to group B [ total effect total cost(TE/TC =764.6/4936,15.49％ )vs.(TE/TC =1509.4/4708),32.06％,x2 =6.183,P ＜ 0.01 ].Conclusion IPC can improve the disease condition and achieve excellent cost-effectiveness for community-based COPD patients.

Key words: 
Pulmonary disease,chronic obstructive; Pharmaceutical services; Economies,pharmaceutical