ORCID Profile
0000-0001-7733-7750
Current Organisations
University of Tasmania
,
University of Melbourne
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Publisher: Oxford University Press (OUP)
Date: 04-1997
DOI: 10.1093/RHEUMATOLOGY/36.4.487
Abstract: The prescribing behaviour of Australian and New Zealand rheumatologists was studied in 1994 using a questionnaire, and the results compared with a similar questionnaire administered in 1984. Perceived differences in efficacy and toxicity for disease-modifying anti-rheumatic drugs (DMARDs) and cytotoxics were reported. Over the decade, methotrexate and sulphasalazine have become the most commonly used anti-rheumatic agents, and methotrexate is clearly seen as the most effective drug. Wide variations in monitoring practices for DMARDs were reported, highlighting the need for cost-effectiveness studies on monitoring. There was low usage of functional outcome measurements in assessing patients.
Publisher: Wiley
Date: 05-2012
DOI: 10.5694/MJA10.11474
Abstract: Simulation-based education (SBE) is a rapidly developing method of supplementing and enhancing the clinical education of medical students. Clinical situations are simulated for teaching and learning purposes, creating opportunities for deliberate practice of new skills without involving real patients. Simulation takes many forms, from simple skills training models to computerised full-body mannequins, so that the needs of learners at each stage of their education can be targeted. Emerging evidence supports the value of simulation as an educational technique to be effective it needs to be integrated into the curriculum in a way that promotes transfer of the skills learnt to clinical practice. Currently, SBE initiatives in Australia are fragmented and depend on local enthusiasts Health Workforce Australia is driving initiatives to develop a more coordinated national approach to optimise the benefits of simulation.
Publisher: AMPCo
Date: 02-2006
Publisher: Springer Science and Business Media LLC
Date: 03-1981
DOI: 10.1038/CLPT.1981.48
Abstract: Clofibric acid disposition was studied in four healthy men after 1 wk of clofibrate ingestion (500 mg orally every 12 hr) with and without probenecid (500 mg orally every 6 hr). Mean (+/- SD) free clofibric acid plasma concentration in the four subjects over a dosage interval at steady state was 2.5 +/- 0.03 mg/1 before and 9.05 +/- 1.09 mg/1 after the probenecid. Probenecid reached an average plasma concentration of 71.3 mg/1. No clofibric acid glucuronide was detected in plasma during either treatment. The fractions of the dose recovered in urine as clofibric acid, clofibric acid glucuronide, and clofibric acid liberated after acid hydrolysis were not altered by probenecid. These data suggest that probenecid causes a reduction in renal and metabolic clearance of clofibric acid, probably as a result of inhibition of the conjugation of clofibric acid with glucuronide.
Publisher: AMPCo
Date: 2001
DOI: 10.5694/J.1326-5377.2001.TB143141.X
Abstract: Australia's present erse and dynamic medical education environment has been shaped by: university funding increases by governments in the 1960s and 70s to promote Australia as a "clever" country the Karmel Report's recommendations of increases in student numbers, new medical schools and a community focus for medical education the successful innovations in entrance requirements and curricula of the most recent medical schools -Newcastle and Flinders the formation of the Australian Medical Council, with a mandate to replace the British General Medical Council's accreditation of and restrictions on Australian medical school courses the Doherty Report, which identified the close relationship between medical education, funding and workforce issues the change to graduate entry and a four-year course for several Australian medical schools and changing patterns of healthcare delivery, the imperative for increasing access to healthcare in rural areas, and the communication revolution made possible by information technology.
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4478194
Publisher: BMJ
Date: 02-1976
DOI: 10.1136/ARD.35.1.40
Abstract: A significant rise in immunoreactive gastrin in a proportion of patients with rheumatoid arthritis is confirmed. Such a rise does not seem to occur in other inflammatory or tissue destructive diseases. The patients with raised immunoreactive gastrin appear to form a separate population but the factors determining this separation remain obscure. Anti-inflammatory drugs, at least during short-term administration have no influence on immunoreactive gastrin concentrations.
Publisher: Wiley
Date: 06-1979
Publisher: AMPCo
Date: 06-2012
DOI: 10.5694/MJA11.10919
Abstract: Changes in health service delivery and issues of quality of care and safety are driving interprofessional practice, and interprofessional learning (IPL) is now a requirement for medical school accreditation. There is international agreement that learning outcomes frameworks are required for the objectives of IPL to be fully realised, but there is debate about the most appropriate terminology. Interprofessional skills can be gained in several ways - from formal educational frameworks, at pre- and post-registration levels to work-based training. Research activity suggests that many consider that IPL delivers much-needed skills to health professionals, but some systematic reviews show that evidence of a link to patient outcomes is lacking. Australian efforts to develop an evidence base to support IPL have progressed, with new research drawing on recommendations of experts in the area. The focus has now shifted to curriculum development. The extent to which IPL is rolled out in Australian universities will depend on engagement and endorsement from curriculum managers and the broader faculty.
Publisher: Oxford University Press (OUP)
Date: 11-1995
DOI: 10.1093/RHEUMATOLOGY/35.11.1154
Abstract: Injectable gold compounds have enjoyed widespread, but occasionally controversial, use in rheumatoid arthritis since the 1920s. This overview examines the data from controlled trials and longer-term observational studies. We conclude that gold is equivalent to other widely used second-line agents in terms of efficacy. Toxicity profiles are similar, apart from methotrexate. It is most efficacious and toxic in the first 2 yr of treatment. There appears to be a dose-response relationship for both efficacy and toxicity. Gold is one of the few agents that decreases the rate of progression of erosions (RR 0.38, 95% CI 0.23-064). Gold compounds, therefore, have a definite place in the rheumatologist's armamentarium, but further research is required to determine optimal monitoring regimes as well as the role of maintenance therapy and combination therapy.
Publisher: Springer Science and Business Media LLC
Date: 30-09-1999
Abstract: This ongoing multicentre prospective phase I/II trial enrolled 74 consecutive patients from 22 centres worldwide with severe autoimmune disease, 35 with rheumatological disorders, 31 with neurological, five with haematological and three with vasculitides. They were treated with autologous peripheral blood or bone marrow transplants according to predetermined criteria. Two patients died after mobilisation before transplant. Seventy-two patients were given 73 transplants, seven bone marrow, and 66 mobilised peripheral blood stem cell transplants. The graft was manipulated to remove T and/or B cells in 43 cases. All 73 transplants engrafted. Five patients died of transplant-related complications: two from bleeding, three from infections. Two patients died of progressive disease. The transplant-related mortality at 1 year of 9% (1-17% 95% CI) is comparable to the transplant-related mortality of 6% (3-9% 95% CI) in patients transplanted during the same period in Europe for non-Hodgkin's lymphoma in sensitive relapse (P = 0.39). Sixty patients are evaluable for response, 40 patients (65%) showed some improvement in their disease. Haematopoietic stem cell transplants are feasible for patients with severe refractory autoimmune disease. Transplant-related mortality is comparable to results in patients with non-Hodgkin's lymphoma in responsive relapse. Two-thirds of the patients show at least some response. These preliminary data are promising. Although associated with considerable risk, randomised trials comparing autologous stem cell transplants to conventional therapy are warranted.
Publisher: BMJ
Date: 05-2004
Publisher: BMJ
Date: 06-09-1975
Abstract: DNA damage caused by UV radiation initiates cellular recovery mechanisms, which involve activation of DNA damage response pathways, cell cycle arrest and apoptosis. To assess cellular transcriptional responses to UVC-induced DNA damage we compared time course responses of human skin fibroblasts to low and high doses of UVC radiation known to induce a transient cellular replicative arrest or apoptosis, respectively. UVC radiation elicited >3-fold changes in 460 out of 12,000 transcripts and 89% of these represented downregulated transcripts. Only 5% of the regulated genes were common to both low and high doses of radiation. Cells inflicted with a low dose of UVC exhibited transcription profiles demonstrating transient regulation followed by recovery, whereas the responses were persistent after the high dose. A detailed clustering analysis and functional classification of the targets implied regulation of biologically ergent responses and suggested involvement of transcriptional and translational machinery, inflammatory, anti-proliferative and anti-angiogenic responses. The data support the notion that UVC radiation induces prominent, dose-dependent downregulation of transcription. However, the data strongly suggest that transcriptional repression is also target gene selective. Furthermore, the results demonstrate that dose-dependent induction of cell cycle arrest and apoptosis by UVC radiation are transcriptionally highly distinct responses.
Publisher: BMJ
Date: 09-2002
DOI: 10.1136/ARD.61.9.818
Abstract: To determine costs related to living with rheumatoid arthritis (RA), and to identify the association between health status-as measured by the Health Status Questionnaire short form-36 (SF-36) and the disease specific index Health Assessment Questionnaire (HAQ)-and the social impact of RA. A prospective cohort study was carried out on 81 patients with RA who completed four consecutive three month cost diaries. The SF-36, HAQ, and social impact at baseline and one year follow up were also assessed. Women reported worse SF-36 physical function and HAQ scores than men and received more assistance from family and friends. Women spent more on non-prescription medication and devices to assist them than men. Older patients had higher expenditure on visits to health professionals, whereas younger patients spent more on prescription medication and tests. Pension status and membership of private health insurance schemes were important determinants in these differences in expenditure. Costs increased with duration of disease, those with private health insurance had greater out of pocket costs (excluding membership fees), and those with pension support had fewer costs. Women were more affected by RA than men in health status, social impact, and out of pocket costs.
Publisher: Springer Science and Business Media LLC
Date: 02-1976
DOI: 10.1007/BF01972199
Publisher: Informa Healthcare
Date: 1974
DOI: 10.1185/03007997409115236
Abstract: Direct laryngoscopy with the Miller laryngoscope (Mil) for infant tracheal intubation is often difficult to use even for skilled professionals. We performed a simulation trial evaluating the utility of a tracheal tube introducer (gum-elastic bougie (GEB)) in a simulated, difficult infant airway model. Fifteen anesthesiologists performed tracheal intubation on an infant manikin at three different degrees of difficulty (normal [Cormack-Lehane grades (Cormack) 1-2], cervical stabilization [Cormack 2-3], and anteflexion [Cormack 3-4]) with or without a GEB, intubation success rate, and intubation time. In the normal and cervical stabilization trials, all intubation attempts were successful regardless of whether or not the GEB was used. In contrast, only one participant succeeded in tracheal intubation without the GEB in the anteflexion trial the success rate significantly improved with the GEB (P = 0.005). Intubation time did not significantly change under the normal trial with or without the GEB (without, 12.7 ± 3.8 seconds with, 13.4 ± 3.6 seconds) but was significantly shorter in the cervical stabilization and anteflexion trials with the GEB. GEB use shortened the intubation time and improved the success rate of difficult infant tracheal intubation by anesthesiologists in simulations.
Publisher: Elsevier BV
Date: 1987
DOI: 10.3109/00313028709066567
Abstract: The effects of histamine, 5-hydroxytryptamine (5-HT) and prostaglandin E2 (PGE2) on plasma protein extravasation in the rat subcutaneous air-pouch have been studied. Both histamine and 5-HT produced increases in plasma protein extravasation which were inhibited by specific receptor antagonists. Plasma protein extravasation induced by PGE2 was partially inhibited by either a 5-HT receptor antagonist (methysergide) or by a combination of H1 and H2 receptor antagonists (mepyramine and cimetidine). A combination of all three antagonists further reduced plasma protein extravasation. These results suggest that PGE2 increases vascular permeability indirectly via the degranulation of mast cells. This supposition was confirmed by histological evidence of extensive mast cell degranulation following the injection of PGE2 but not following histamine, 5-HT or saline injection. Using a technique of vascular labelling, following the intravenous injection of Monastral blue dye, plasma extravasation induced by histamine, 5-HT or PGE2 was observed to be restricted to post-capillary venules and was not observed in arterioles or capillaries. Electron microscopic examination of the tissue revealed the presence of monastral blue particles trapped between endothelial cells. These findings suggest that the microcirculation of the rat subcutaneous air-pouch behaves in an analogous manner to that of other tissues.
Publisher: Wiley
Date: 08-1974
Publisher: The American Association of Immunologists
Date: 09-2000
DOI: 10.4049/JIMMUNOL.165.5.2790
Abstract: Human type IIA secretory phospholipase A2 (sPLA2-IIA) is induced in association with several immune-mediated inflammatory conditions. We have evaluated the effect of sPLA2-IIA on PG production in primary synovial fibroblasts from patients with rheumatoid arthritis (RA). At concentrations found in the synovial fluid of RA patients, exogenously added sPLA2-IIA dose-dependently lified TNF-α-stimulated PGE2 production by cultured synovial fibroblasts. Enhancement of TNF-α-stimulated PGE2 production in synovial cells was accompanied by increased expression of cyclooxygenase (COX)-2 and cytosolic phospholipase A2 (cPLA2)-α. Blockade of COX-2 enzyme activity with the selective inhibitor NS-398 prevented both TNF-α-stimulated and sPLA2-IIA- lified PGE2 production without affecting COX-2 protein induction. However, both sPLA2-IIA- lified PGE2 production and enhanced COX-2 expression were blocked by the sPLA2 inhibitor LY311727. Colocalization studies using triple-labeling immunofluorescence microscopy showed that sPLA2-IIA and cPLA2-α are coexpressed with COX-2 in discrete populations of CD14-positive synovial macrophages and synovial tissue fibroblasts from RA patients. Based on these findings, we propose a model whereby the enhanced expression of sPLA2-IIA by RA synovial cells up-regulates TNF-α-mediated PG production via superinduction of COX-2. Therefore, sPLA2-IIA may be a critical modulator of cytokine-mediated synovial inflammation in RA.
Publisher: Elsevier BV
Date: 11-2018
Publisher: CSIRO Publishing
Date: 26-07-2022
DOI: 10.1071/AH22158
Abstract: As we review health governance during the COVID-19 pandemic, we have an opportunity to reflect on these processes and ensure that future challenges might be managed in a more collaborative and whole of system response. This ‘Perspective’ reviews COVID-19 responses in Australia, reflects on a number of potential solutions that have been developed by organisations over the past two decades and proffers a governance framework for a Communicable Disease and Pandemic Management Authority that might assist health responses to future challenges.
Publisher: AMPCo
Date: 12-1977
DOI: 10.5694/J.1326-5377.1977.TB107717.X
Abstract: Rheumatoid arthritis remains an incurable disease, and the patient who is unable to obtain relief from standard therapies will often turn to one of the many alternative treatments available. We report an episode of agranulocytosis which occurred in a patient with rheumatoid arthritis while he was taking a Chinese herbal preparation. We understand this preparation is readily obtainable by Australians.
Publisher: Elsevier BV
Date: 1987
DOI: 10.1016/0378-4347(87)80162-7
Abstract: Spots of blood are routinely collected from newborn babies onto filter paper called Guthrie cards and used to screen for metabolic and genetic disorders. The archived dried blood spots are an important and precious resource for genomic research. Whole genome lification of dried blood spot DNA has been used to provide DNA for genome-wide SNP genotyping. Here we describe a 96 well format procedure to extract DNA from a portion of a dried blood spot that provides sufficient un lified genomic DNA for genome-wide single nucleotide polymorphism (SNP) genotyping. We show that SNP genotyping of the un lified DNA is more robust than genotyping lified dried blood spot DNA, is comparable in cost, and can be done with thousands of s les. This procedure can be used for genome-wide association studies and other large-scale genomic analyses that require robust, high-accuracy genotyping of dried blood spot DNA.
Publisher: Oxford University Press (OUP)
Date: 03-1990
DOI: 10.1111/J.1365-2249.1990.TB08092.X
Abstract: The anti-rheumatic gold compounds gold sodium thiomalate (GST) and auranofin (AF) have variable and often unpredictable effects in patients treated for arthritis As inhibition of interleukin-1 (IL-1) production may be an important effect of these drugs, we investigated their effect on IL-1 production by lipopolysaccharide (LPS) stimulated monocytes in a serum-free. non-adherent culture system. A bi-modal effect was observed: low concentrations (GST 10–250 ng/ml and AF 1–100 ng/ml) potentiated IL-1 production, and higher concentrations (GST 200–1000 ng/ml and AF10–500 ng/ml) inhibited This bi-modal effect was observed for both secreted and cell-associated IL-1 activity with the exception that GST failed to inhibit cell-associated IL-1 generation. The potentiating effect was dependent on the continuous presence of gold for at least the first few hours after LPS stimulation. The inhibitory effect of GST was dependent on its presence after LPS Stimulation while that of AF was evident even if cells were pretreated with AF and washed before exposure to LPS. There was considerable in idual variation in IL-1 production in response to LPS as well as in the effects of gold on cells from both healthy in iduals and patients with arthritis. There was also some overlap in the range of concentrations of gold that potentiated and inhibited IL-1 production, and there was relative insensitivity to the inhibitory effects of gold in certain in iduals. These results may explain some of the variability in the response of patients to chrysotherapy and support further studies to see if these in vitro effects might predict clinical response to gold.
Publisher: Springer Science and Business Media LLC
Date: 08-1989
DOI: 10.1007/BF00270249
Publisher: Informa Healthcare
Date: 1976
DOI: 10.1185/03007997609109288
Abstract: The authors review the trials carried out on azapropazone in rheumatoid arthritis and other rheumatoid conditions. They comment that in terms of efficacy azapropazone would appear to be a useful non-steroidal anti-inflammatory analgesic which compares favourably with other established antirheumatic agents against which it has been tested. Its main advantages are its low incidence of side-effects and the fact that in the majority of the trials reported azapropazone treatment was preferred by patients to that with other agents.
Publisher: SAGE Publications
Date: 09-12-2022
DOI: 10.1177/1357633X221136305
Abstract: The Victorian COVID-19 Cancer Network (VCCN) Telehealth Expert Working Group aimed to evaluate the telehealth (TH) experience for cancer patients, carers and clinicians with the rapid uptake of TH in early 2020 during the COVID-19 pandemic. We conducted a prospective multi-centre cross-sectional survey involving eight Victorian regional and metropolitan cancer services and three consumer advocacy groups. Patients or their carers and clinicians who had TH consultations between 1 July 2020 and 31 December 2020 were invited to participate in patient and clinician surveys, respectively. These surveys were opened from September to December 2020. The acceptability of TH via both video (82.9%) and phone (70.4%) were high though acceptability appeared to decrease in older phone TH users. Video was associated with higher satisfaction compared to phone (87.1% vs 79.7%) even though phone was more commonly used. Various themes from the qualitative surveys highlighted barriers and enablers to rapid TH implementation. The high TH acceptability supports this as a safe and effective strategy for continued care and should persist beyond the pandemic environment, where patient preferences are considered and clinically appropriate. Ongoing support to health services for infrastructure and resources, as well as expansion of reimbursement eligibility criteria for patients and health professionals, including allied health and nursing, are crucial for sustainability.
Publisher: BMJ
Date: 09-06-2014
DOI: 10.1136/ANNRHEUMDIS-2014-205393
Abstract: The objective of this paper is to provide an overview of the strengths, limitations and lessons learned from estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Disease 2010 Study (GBD 2010 Study). It should be read in conjunction with the other GBD 2010 Study papers published in this journal. The strengths of the GBD 2010 Study include: the involvement of a MSK expert group development of new and more valid case definitions, functional health states, and disability weights to better reflect the MSK conditions the extensive series of systematic reviews undertaken to obtain data to derive the burden estimates and the use of a new, more advanced version of the disease-modelling software (DisMod-MR). Limitations include: many regions of the world did not have data the extent of heterogeneity between included studies and burden does not include broader aspects of life, such as participation and well-being. A number of lessons were learned. Ongoing involvement of experts is critical to ensure the success of future efforts to quantify and monitor this burden. A paradigm shift is urgently needed among global agencies in order to alleviate the rapidly increasing global burden from MSK conditions. Prevention and control of MSK disability are required, along with health system changes. Further research is needed to improve understanding of the predictors and clinical course across different settings, and the ways in which MSK conditions can be better managed and prevented.
Publisher: The Journal of Rheumatology
Date: 05-2019
Abstract: The Outcome Measures in Rheumatology (OMERACT) Safety Working Group objective was to identify harm domains from existing outcome measurements in rheumatology. Systematically searching the MEDLINE database on January 24, 2017, we identified full-text articles that could be used for harm outcomes in rheumatology. Domains/items from the identified instruments were described and the content synthesized to provide a preliminary framework for harm outcomes. From 435 possible references, 24 were read in full text and 9 were included: 7 measurement instruments were identified. Investigation of domains/items revealed considerable heterogeneity in the grouping and approach. The ideal way to assess harm aspects from the patients’ perspective has not yet been ascertained.
Publisher: Wiley
Date: 05-1989
DOI: 10.1111/J.1365-2125.1989.TB03423.X
Abstract: 1. Enteric coated sodium salicylate 4.8 g daily was compared with the same dose of enteric coated aspirin in 18 patients with rheumatoid arthritis. 2. After an initial washout period lasting 3 days, patients were randomly allocated to treatment with sodium salicylate or aspirin. After 2 weeks the two treatments were crossed over. 3. Pain relief, reduction in articular index of joint tenderness, increase in grip strength, decrease in digital joint circumference and patients' assessment showed significant improvement with both treatments compared with the washout period. No significant differences were found between the two therapies. 4. No correlation was found in the degree of improvement in any of the clinical outcomes and the salicylate concentrations at steady state.
Publisher: Wiley
Date: 2018
DOI: 10.1111/IMJ.13661
Abstract: Health systems around the world face the issue of financial and workforce sustainability. Mobile health technologies - those devices which connect health professionals, patients, payers and the many other contributors who make up the health system offer some solutions - not just as 'add ons' but as enablers of real system change. This paper presents a vision for what the health system of the future could be like and emphasises the opportunities for real patient participation in clinical decision-making if the professions can engage the technologies and patients/community in a meaningful way. Predicting the future is never easy but many of the technologies are here now - but how we will use them to make the system more patient friendly, more productive and sustainable is still for discussion. This paper should start that conversation.
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.BERH.2013.10.007
Abstract: The latest Global Burden of Disease Study, published at the end of 2012, has highlighted the enormous global burden of low back pain. In contrast to the previous study, when it was ranked 105 out of 136 conditions, low back pain is now the leading cause of disability globally, ahead of 290 other conditions. It was estimated to be responsible for 58.2 million years lived with disability in 1990, increasing to 83 million in 2010. This chapter illustrates the ways that the Global Burden of Disease data can be displayed using the data visualisation tools specifically designed for this purpose. It also considers how best to increase the precision of future global burden of low back pain estimates by identifying limitations in the available data and priorities for further research. Finally, it discusses what should be done at a policy level to militate against the rising burden of this condition.
Publisher: Oxford University Press (OUP)
Date: 2199
DOI: 10.1093/RHEUMATOLOGY/36.1.95
Abstract: The objective of this study was to use the technique of meta-analysis to undertake a systematic review of published and unpublished randomized controlled trials of pharmacological agents to determine their relative efficacy and toxicity in the treatment of psoriatic arthritis. The main outcome measure was the change in pooled disease index with component variables derived from OMERACT. Nineteen randomized trials were identified, of which 12 were included in the quantitative analysis with data from 792 subjects. Although all agents were better than placebo, parenteral high-dose methotrexate, salazopyrin, azathioprine and etretinate were the agents that achieved statistical significance (although it should be noted that only one component variable was available for azathioprine and only one trial with a high dropout rate was available for etretinate suggesting some caution is necessary in interpreting these results). In all trials, the placebo group improved over baseline (pooled improvement 0.43 disease index (DI) units, 95% CI 0.28-0.59). There were insufficient data to examine toxicity. In conclusion, parenteral high-dose methotrexate and salazopyrin are the only two agents with well-demonstrated published efficacy in psoriatic arthritis. The magnitude of the effect seen with etretinate, oral low-dose methotrexate, azathioprine and perhaps colchicine suggests that they may be effective, but that further multicentre clinical trials are required to establish their efficacy. Furthermore, the magnitude of the improvement observed in the placebo group strongly suggests that uncontrolled trials should not be used to guide management decisions in this condition.
Publisher: Springer Science and Business Media LLC
Date: 06-2001
Publisher: Wiley
Date: 06-10-2020
DOI: 10.1111/PAN.14018
Publisher: Wiley
Date: 08-1980
DOI: 10.1111/J.1440-1681.1980.TB00082.X
Abstract: 1. When six female seropositive rheumatoid patients were given placebo therapy for 48 h, their plasma kininogen level, 9.2 +/- 0.7 microgram bradykinin equivalents (bk eq) per ml, was found to be 59% greater than that of a group of eight healthy female volunteers (5.8 +/- 0.5 microgram/ml). 2. When the rheumatoid patients received aspirin therapy for 1 week, their mean plasma kininogen concentration fell by 31% to 6.3 +/- 0.8 microgram Bk eq/ml. This was accompanied by a 20.4% fall in mean plasma alpha 2-globulin level. Haematocrit and total plasma protein were not significantly altered (P > 0.05). 3. The fall in kininogen was very rapid, the main reduction occurring within the first hour. 4. Aspirin therapy greatly reduced the pain assessments but had no effect on plasma concentrations of IgG, IgA, IgM, complement component C3, nor on ESR, haemoglobin, leucocyte count, nor ring size. Left hand grip strength was increased while right hand grip strength was unchanged. 5. The action of aspirin on plasma kininogen and alpha 2-globulin was similar to that of indomethacin. Plasma kininogen has been considered to be an acute phase reactant. The possible diagnostic value of plasma kininogen estimation is discussed.
Publisher: AMPCo
Date: 08-2003
Publisher: Informa Healthcare
Date: 1976
DOI: 10.1185/03007997609109281
Abstract: A trial to compare the therapeutic potential of 1200 mg. azapropazone daily with 3.9 g. aspirin daily was carried out in 108 out-patients with rheumatoid arthritis over a 14-day period. Analysis of results from the 85 patients with completed assessment data (49 on azapropazone 36 on aspirin) showed that azapropazone was better than aspirin from the point of view of pain relief, number of days patients were withdrawn prematurely from the trial, and patient satisfaction with treatment. The differences, however, were not statistically significant. The authors compare the results obtained in this trial with those obtained previously from trials with 13 other antirheumatic drugs using the same method.
Publisher: Wiley
Date: 12-1983
DOI: 10.1111/J.1365-2125.1983.TB02252.X
Abstract: Ranitidine disposition has been studied in 12 patients with renal impairment following 50 mg given intravenously and 150 mg given by mouth on separate occasions. The clearance of ranitidine from plasma (y) was correlated with creatinine clearance (x): y = 10.47 + 0.289x,r2 = 0.751, but there was no significant correlation of creatinine clearance with distribution volume or bioavailability. The mean (s.e. mean) distribution volume was 1.62 (0.08) 1/kg and the mean bioavailability 0.81 (0.05). These data suggest that in order to obtain similar ranitidine plasma concentrations in anephric patients and patients with normal renal function, the maintenance dose in the anephric patients should be 25-30% of that for patients with normal renal function.
Publisher: AMPCo
Date: 09-1977
DOI: 10.5694/J.1326-5377.1977.TB114594.X
Abstract: A drug surveillance programme involving pharmacists in a general medical ward has been shown to reduce the number of drugs prescribed to patients and also to reduce the number of dispensing errors. The evidence presented suggests that continuing involvement of pharmacists in patient care at the ward level is required to maintain the improved prescribing habits.
Publisher: SAGE Publications
Date: 10-2006
Abstract: Research councils, agencies, and researchers recognize the benefits of team-based health research. However, researchers involved in large-scale team-based research projects face multiple challenges as they seek to identify epistemological and ontological common ground. Typically, these challenges occur between quantitative and qualitative researchers but can occur between qualitative researchers, particularly when the project involves multiple disciplinary perspectives. The authors use the convergent interviewing technique in their multidisciplinary research project to overcome these challenges. This technique assists them in developing common epistemological and ontological ground while enabling swift and detailed data collection and analysis. Although convergent interviewing is a relatively new method described primarily in marketing research, it compares and contrasts well with grounded theory and other techniques. The authors argue that this process provides a rigorous method to structure and refine research projects and requires researchers to identify and be accountable for developing a common epistemological and ontological position.
Publisher: The Journal of Rheumatology
Date: 15-01-2019
Abstract: Outcome Measures in Rheumatology (OMERACT) convened a premeeting in 2018 to bring together patients, regulators, researchers, clinicians, and consumers to build upon previous OMERACT drug safety work, with patients fully engaged throughout all phases. Day 1 included a brief introduction to the history of OMERACT and methodology, and an overview of current efforts within and outside OMERACT to identify patient-reported medication safety concerns. On Day 2, two working groups presented results after each, breakout groups were assembled to discuss findings. Five themes pertaining to drug safety measurement emerged. Current approaches have failed to include data from the patient’s perspective. A better understanding of how in iduals with rheumatic diseases view potential benefits and harms of therapies is essential.
Publisher: Wiley
Date: 11-1999
DOI: 10.1002/1529-0131(199911)42:11<2286::AID-ANR5>3.0.CO;2-X
Publisher: The Journal of Rheumatology
Date: 08-2017
Abstract: While there has been substantial progress in the development of core outcomes sets, the degree to which these are used by researchers is variable. We convened a special workshop on knowledge translation at the Outcome Measures in Rheumatology (OMERACT) 2016 with 2 main goals. The first focused on the development of a formal knowledge translation framework and the second on promoting uptake of recommended core outcome domain and instrument sets. We invited all 189 OMERACT 2016 attendees to the workshop 86 attended, representing patient research partners (n = 15), healthcare providers/clinician researchers (n = 52), industry (n = 4), regulatory agencies (n = 4), and OMERACT fellows (n = 11). Participants were given an introduction to knowledge translation and were asked to propose and discuss recommendations for the OMERACT community to (1) strengthen stakeholder involvement in the core outcome instrument set development process, and (2) promote uptake of core outcome sets with a specific focus on the potential role of post-regulatory decision makers. We developed the novel “OMERACT integrated knowledge translation” framework, which formalizes OMERACT’s knowledge translation strategies. We produced strategies to improve stakeholder engagement throughout the process of core outcome set development and created a list of creative and innovative ways to promote the uptake of OMERACT’s core outcome sets. The guidance provided in this paper is preliminary and is based on the views of the participants. Future work will engage OMERACT groups, “post-regulatory decision makers,” and a broad range of different stakeholders to identify and evaluate the most useful methods and processes, and to revise guidance accordingly.
Publisher: Springer US
Date: 1976
DOI: 10.1007/978-1-4684-3267-1_41
Abstract: Recombinant adeno-associated virus (rAAV) vectors mediate long-term gene transfer without any known toxicity. The primary limitation of rAAV has been the small size of the virion (20 nm), which only permits the packaging of 4.7 kilobases (kb) of exogenous DNA, including the promoter, the polyadenylation signal and any other enhancer elements that might be desired. Two recent reports (D Duan et al: Nat Med 2000, 6:595-598 Z Yan et al: Proc Natl Acad Sci USA 2000, 97:6716-6721) have exploited a unique feature of rAAV genomes, their ability to link together in doublets or strings, to bypass this size limitation. This technology could improve the chances for successful gene therapy of diseases like cystic fibrosis or Duchenne muscular dystrophy that lead to significant pulmonary morbidity.
Publisher: Wiley
Date: 2021
DOI: 10.1111/IMJ.15039
Publisher: Wiley
Date: 10-1985
DOI: 10.1111/J.1365-2125.1985.TB05087.X
Abstract: The disposition of prednisolone has been studied in eight male subjects with and without the concomitant administration of cortisol which produced plasma cortisol concentrations 10-fold higher than endogenous levels. The clearance and steady-state distribution volume of total prednisolone were increased as was the prednisolone free fraction but the clearance of unbound prednisolone was unaltered by cortisol co-administration.
Publisher: Wiley
Date: 02-2018
DOI: 10.1111/IMJ.13654
Abstract: The EVOLVE (evaluating evidence, enhancing efficiencies) initiative aims to drive safer, higher-quality patient care through identifying and reducing low-value practices. To determine the Australian Rheumatology Association's (ARA) 'top five' list of low-value practices. A working group comprising 19 rheumatologists and three trainees compiled a preliminary list. Items were retained if there was strong evidence of low value and there was high or increasing clinical use and/or increasing cost. All ARA members (356 rheumatologists and 72 trainees) were invited to indicate their 'top five' list from a list of 12-items through SurveyMonkey in December 2015 (reminder February 2016). A total of 179 rheumatologists (50.3%) and 19 trainees (26.4%) responded. The top five list (percentage of rheumatologists, including item in their top five list) was: Do not perform arthroscopy with lavage and/or debridement for symptomatic osteoarthritis of the knee nor partial meniscectomy for a degenerate meniscal tear (73.2%) Do not order anti-nuclear antibody (ANA) testing without symptoms and/or signs suggestive of a systemic rheumatic disease (56.4%) Do not undertake imaging for low back pain for patients without indications of an underlying serious condition (50.8%) Do not use ultrasound guidance to perform injections into the subacromial space as it provides no additional benefit in comparison to landmark-guided injection (50.3%) and Do not order anti-double-stranded DNA antibodies in ANA negative patients unless the clinical suspicion of systemic lupus erythematosus remains high (45.3%). This list is intended to increase awareness among rheumatologists, other clinicians and patients about commonly used low-value practices that should be questioned.
Publisher: Informa Healthcare
Date: 1985
DOI: 10.1185/03007998509109609
Abstract: Eleven patients with osteoarthritis and mild hypertension completed an 8-week, double-blind crossover study in which 200 mg tiaprofenic acid 3-times daily or placebo were substituted for their normal non-steroidal anti-inflammatory therapy. Systolic blood pressure was significantly higher on tiaprofenic acid therapy than on placebo and plasma renin activity was significantly lower on active treatment. No significant changes were seen in biochemical parameters, though the weight of the patient was also higher on tiaprofenic acid than on placebo. Duration of morning stiffness was also lower on tiaprofenic acid than on placebo. Blood pressure on tiaprofenic acid was not different from baseline readings on other non-steroidal anti-inflammatory drug therapy. This study suggests that tiaprofenic acid, like other non-steroidal anti-inflammatory agents, may interfere with blood pressure control in treated hypertensive patients.
Publisher: Wiley
Date: 18-05-2005
Publisher: Springer Netherlands
Date: 1987
Publisher: Elsevier BV
Date: 12-2012
Publisher: BMJ
Date: 09-1998
DOI: 10.1136/ARD.57.9.550
Abstract: To determine the localisation and level of expression of human type IIa secretory phospholipase A2 (sPLA2) in the synovium of rheumatoid arthritis (RA), osteoarthritis (OA), and non-arthritic (NA) patients and to examine the relation between sPLA2 and histological features of inflammation. Immunoperoxidase staining using the anti-sPLA2 monoclonal antibody 9C1 was performed on frozen sections of knee synovium of 10 RA, 10 OA, and 10 NA patients. sPLA2 positive cells were scored on a scale of 0-3 in 10 fields of a representative tissue section from each case. Double labelling immunofluorescence confocal microscopy with antibodies to CD14 or CD45 and 9C1 was used to determine cell type specificity. Inflammation was assessed by semiquantitative scoring of lining layer thickness and mononuclear cell infiltrates (MC) and a cumulative inflammation score, generated by summing the two parameters. Scores in each group were compared using non-parametric statistical analysis. sPLA2 was localised to endothelium (EC), vascular smooth muscle (VSM), and mast cells (M) in all tissue sections. In RA and OA sections, staining was seen in both macrophage-like and fibroblast-like cells in the synovial lining layer (LL) and subsynovial lining layer (SLL). Perineural cells stained positively. Subintimal lymphoid aggregates (LA) were negative in all sections. The RA group showed significantly greater staining in extravascular synovial tissue (median 3.6, range 1.5-6.0) than the OA (median 1.95, range 0-5.3) or NA (median 0, range 0-5.9) groups (p < 0.05). LL staining was significantly higher in RA than both OA and NA sections (p < 0.05). The OA group showed a trend to higher staining scores than the NA group that did not reach significance. There was a significant correlation between the sPLA2 staining score and inflammation score within the RA patient group (p < 0.05). The synovium is a site of increased expression of sPLA2 antigen in both RA and OA relative to NA. Its presence in both fibroblast and macrophage-like cells in the LL and SLL of synovial tissue in RA and OA, but not NA, indicates that the enzyme is specifically induced in these regions in both conditions with expression in the LL being particularly characteristic of RA. The widespread expression of sPLA2 in synovium suggests it is likely to play a significant part in synovial pathology.
Publisher: Informa Healthcare
Date: 1975
Publisher: Oxford University Press (OUP)
Date: 1989
DOI: 10.1093/RHEUMATOLOGY/28.1.7
Abstract: The benefits of patient education for those with chronic arthritis are well documented. Informed patients should practice self care more often, and may show reduced disability from their disease. An important question relates to maintenance of the knowledge and skills acquired in educational programmes. This prospective study evaluated an education programme for people with rheumatoid arthritis (RA) and osteoarthritis (OA). The intervention group participated in a comprehensively planned six session behaviourally based programme. A questionnaire was given to 100 patients and 95 matched but non-random controls before the programme, 1 month later, and at 3 and 12 months. The intervention group demonstrated improvements in knowledge, self-reported health behaviour and disability scores at 12 months, compared to the controls. No differences were reported in symptoms, compliance with therapy, pain perception, and locus of control.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2018
DOI: 10.1007/S00586-018-5720-Z
Abstract: Spine-related disorders are a leading cause of global disability and are a burden on society and to public health. Currently, there is no comprehensive, evidence-based model of care for spine-related disorders, which includes back and neck pain, deformity, spine injury, neurological conditions, spinal diseases, and pathology, that could be applied in global health care settings. The purposes of this paper are to propose: (1) principles to transform the delivery of spine care (2) an evidence-based model that could be applied globally and (3) implementation suggestions. The Global Spine Care Initiative (GSCI) meetings and literature reviews were synthesized into a seed document and distributed to spine care experts. After three rounds of a modified Delphi process, all participants reached consensus on the final model of care and implementation steps. Sixty-six experts representing 24 countries participated. The GSCI model of care has eight core principles: person-centered, people-centered, biopsychosocial, proactive, evidence-based, integrative, collaborative, and self-sustaining. The model of care includes a classification system and care pathway, levels of care, and a focus on the patient's journey. The six steps for implementation are initiation and preparation assessment of the current situation planning and designing solutions implementation assessment and evaluation of program and sustain program and scale up. The GSCI proposes an evidence-based, practical, sustainable, and scalable model of care representing eight core principles with a six-step implementation plan. The aim of this model is to help transform spine care globally, especially in low- and middle-income countries and underserved communities. These slides can be retrieved under Electronic Supplementary Material.
Publisher: Wiley
Date: 04-2000
DOI: 10.1111/J.1445-5994.2000.TB00810.X
Abstract: The continuing uncertainty about the silica-systemic sclerosis relationship led to the investigation of its role as a disease determinant in a large population-based study of systemic sclerosis. To compare the frequency, socioeconomic and educational status, age-specific prevalence and duration of occupational silica exposure in males with and without systemic sclerosis. To assess the temporal relationship between exposure and disease onset. To estimate disease latency. To compare disease characteristics between silica-exposed and non-silica-exposed male cases. The study was case-control in design. The exposure variable was occupational silica exposure as assessed by an occupational health officer blinded to case/control status and the outcome variable was systemic sclerosis. The employed instrument comprised either a standardised telephone questionnaire (interviewed cases and controls) or medical records (deceased or living-status-unknown cases). Sixty of 160 cases (37.5%) and 11 of 83 (13.3%) controls had occupational silica exposure (OR=3.93 1.84-8.54). Comparison of data between 64 interviewed cases and all controls demonstrated initial occupational silica exposure occurring before age 40, comparable educational status but significantly different cumulative socioeconomic status with cases being over-represented in semi-skilled and unskilled occupations. Cross-sectional 'current' occupational data underestimated cumulative silica exposure by more than 50%. Silica exposure uniformly preceded onset of second disease symptoms and disease diagnosis. In most, it also preceded onset of first disease symptoms. Disease latency approximated two decades. No disease features distinguished silica-associated systemic sclerosis from idiopathic systemic sclerosis. The duration of silica exposure in the interviewed silica-exposed cases did not significantly exceed that of silica-exposed controls. Male systemic sclerosis displays socioeconomic dependence. Silica is a disease determinant in male systemic sclerosis, with disease features including a long latency and clinical characteristics indistinguishable from idiopathic disease. Cross-sectional 'current' occupational data underestimate cumulative occupational silica exposure.
Publisher: Wiley
Date: 02-1987
DOI: 10.1111/J.1476-5381.1987.TB08971.X
Abstract: Monosodium urate (MSU) and calcium pyrophosphate dihydrate (CPPD) crystals initiated acute inflammatory reactions characterized by increased plasma extravasation and polymorphonuclear leukocyte (PMNL) accumulation in the rat subcutaneous air-pouch. Pretreatment of rats with colchicine (1 mg kg-1, s.c.) inhibited PMNL accumulation induced by either crystal type but had a greater inhibitory effect on MSU-induced plasma extravasation compared with that induced by CPPD crystals. Colchicine (1 mg kg-1, s.c.) did not reduce histamine-induced plasma extravasation in the air-pouch. The lipoxygenase product of arachidonic acid metabolism, leukotriene B4 (LTB4), was detected in MSU-induced exudates but not in CPPD-induced exudates. Pretreatment of rats with colchicine (1 mg kg-1, s.c.) inhibited LTB4 production in MSU-induced exudates.
Publisher: Springer Science and Business Media LLC
Date: 10-1984
DOI: 10.1007/BF01972382
Abstract: Managing patients with metastatic pancreatic adenocarcinoma (mPDA) is a challenging proposition for any treating oncologist. Although the potency of first-line therapies has improved with the approvals of FOLFIRINOX and gemcitabine plus nab-paclitaxel, many patients are unable to derive significant benefit from later lines of therapy upon progression. Enrollment on clinical trials remains among the best options for patients with mPDA in all lines of therapy. At our institution, we routinely check for microsatellite instability (MSI-H) and perform next-generation sequencing (NGS) at the time of diagnosis in all good performance status mPDA patients. Although MSI-H status is only found in 1% of patients with mPDA, given pembrolizumab's tissue-agnostic approval for MSI-H tumors in later-line settings, it is a viable option when deciding on subsequent lines of therapy. Any use of immune therapy in mPDA is investigational outside the MSI-H setting. NGS can identify BRCA or other DNA damage response (DDR) defects in patients which can predict sensitivity to platinum-based therapies and influence choice of both initial and later lines of therapy. It can also identify rare actionable genomic alterations such as HER2 (2%) and TRK fusions (0.1%) and offer patients the option of enrollment on clinical trials with agents targeting these or other identified alterations. We believe enrolling mPDA patients on clinical trials with immune-modulating agents is critical to determine if there are other patient subsets, outside of the MSI-H setting, who would benefit from these approaches. Immunotherapy's general tolerability and potential to generate durable responses make it particularly appealing for mPDA patients. Although single-modality immunotherapy such as checkpoint inhibitors or vaccines have not demonstrated efficacy in this disease, combinatorial strategies targeting unique aspects of PDA including the tumor microenvironment and desmoplastic stroma have shown preclinical or early-phase success. Validating these treatments with later-phase prospective studies is essential to making immunotherapy a routine component of the treatment armamentarium for mPDA patients.
Publisher: The Journal of Rheumatology
Date: 09-2009
Abstract: The Effective Consumer Scale (EC-17) comprises 17 items measuring the main skills and behaviors people need to effectively manage their healthcare. We tested the responsiveness of the EC-17. Participants, in 2 waves of a 6-week Arthritis Self-Management Program (ASMP) from Arthritis Ireland, received a questionnaire at the first and last week of the weekly ASMP. The questionnaire included the EC-17 and 10 other measures for arthritis. Deficits, mean change, and standard deviations were calculated at baseline and Week 6. The EC-17 scores were compared to the Arthritis Self-Efficacy (ASE) and Patient Activation Measure (PAM) scales. Results were presented at OMERACT 9. There is some overlap between the EC-17 and the ASE and PAM however, most items of greatest deficit in the EC-17 are not covered by those scales. In 327 participants representing both intervention waves (2006 and 2007), the EC-17 was more efficient than the ASE but less efficient than the PAM for detecting improvements after the ASMP, and was moderately correlated with the PAM. The EC-17 appears to measure different skills and attributes than the ASE and PAM. Discussions with participants at OMERACT 9 agreed that it is worthwhile to measure the skills and attributes of an effective consumer, and supported the development of an intervention (such as proposed online decision aids) that would include education in the categories in the EC-17.
Publisher: Wiley
Date: 06-2012
DOI: 10.1111/J.1445-5994.2012.02801.X
Abstract: Healthcare is considered a service profession and most of what clinicians do is manage information. Thus, information is not a necessary adjunct to care. It is care and effective patient management that require effective management of patients' clinical data. This perspective is supported by the World Health Organisation in its use of the quotation from Gonzalo Vecina Neto, head of the Brazilian National Health Regulatory Agency, 'There is no health without management, and there is no management without information'. This opinion paper discusses how traditional clinical decision-making led 'by the doctor' is unsustainable in the modern era and how e-technologies will facilitate distributed effective decision-making and new isions of labour across the health workforce.
Publisher: Wiley
Date: 05-1995
Abstract: To assess the efficacy and tolerability of sulfasalazine (SSZ) in the treatment of spondylarthropathy. We conducted a 6-month randomized, placebo-controlled, double-blind, multicenter study of patients with spondylarthropathy whose disease had remained active despite treatment with nonsteroidal antiinflammatory drugs. Patients were treated with SSZ (3 gm/day) or placebo. The primary efficacy variables were the physician's and patient's overall assessments, pain, and morning stiffness. End points were analyzed in the intent-to-treat and completer patient populations the time course of effect was analyzed in the completer patient population. Of the 351 patients enrolled, 263 (75%) completed the 6-month treatment period. The withdrawal rates were 35 (20%) and 53 (30%) in the placebo and SSZ groups, respectively. In the intent-to-treat analysis of end point efficacy, the between-treatment difference reached statistical significance only for 1 of the 4 primary outcome variables, the patient's overall assessment of disease activity, for which 60% of the patients taking SSZ improved by at least 1 point on a 5-point scale, in contrast to 44% of the patients taking placebo. Laboratory markers of inflammation also showed statistically significant change in favor of SSZ. In subgroup analysis, the most impressive effects were seen in patients with psoriatic arthritis, both for the 4 primary efficacy variables and for secondary efficacy variables such as the number of inflamed joints. Adverse events were more frequent in the SSZ group than the placebo group, but all were transient or reversible after cessation of treatment. The results of this study show that SSZ had greater efficacy than placebo in the treatment of active spondylarthropathy, notably in patients with psoriatic arthritis.
Publisher: BMJ
Date: 10-1981
DOI: 10.1136/ARD.40.5.470
Abstract: Three case histories of patients with histologically proved malignant disease and an associated nonmetastatic symmetrical polyarthropathy are analysed. No evidence of a pathogenetic role for immune complexes was found in hypertrophic osteoarthropathy, whereas there is considerable evidence suggesting that the nonmetastatic polyarthritis associated with malignant lymphoma is an immune complex phenomenon.
Publisher: AMPCo
Date: 05-1998
DOI: 10.5694/J.1326-5377.1998.TB139023.X
Abstract: To determine the prevalence and determinants of disability among elderly people living in the community. A cross-sectional postal questionnaire survey. Northern Sydney Area Health Service. 1527 residents (622 men and 905 women) aged 65 years and over. Self-reported chronic illnesses, injuries or conditions difficulties with activities of daily living assessed by the Health Assessment Questionnaire (HAQ) and home modification and use of functional aids. "Arthritis or rheumatism" was the leading long term condition, reported by 59.5%, 55.8% and 59.7% of women and 40.5%, 47.0% and 43.6% of men in the three age groups (65-74, 75-84 and 85 years and over), respectively. The back, neck and knees were the most common sites of pain and stiffness. Of the respondents, 23.4% of women and 24.3% of men reported regularly taking nonsteroidal anti-inflammatory drugs. Impaired performance of activities of daily living increased with age, with 53.9%, 70.7% and 89.6% of women and 37.6%, 63.6% and 73.2% of men in the respective age groups reporting at least some difficulty (HAQ score > 0). Multivariate analysis found self-reported poor general health, loss of a limb, arthritis or rheumatism, other long term conditions restricting physical activity, impaired vision, female sex, and age to be significant predictors of disability as measured by HAQ scores. Only 13.9% of women and 9.4% of men had made changes to their home. Functional aids were used by 27.7%, 37.3% and 65.9% of women and 15.6%, 33.4% and 59.1% of men in the respective age groups. Arthritis and rheumatism were the most prevalent chronic conditions among elderly people in the community, and were significantly associated with difficulty with performing activities of daily living, after controlling for effects of age, sex and other chronic conditions.
Publisher: BMJ
Date: 09-03-1974
Abstract: A total of 125 patients with rheumatoid arthritis were investigated about their drug therapy before referral to a specialist centre. Most referrals were from general practitioners. Only 47 of the patients had received salicylates as the first drug and 18 had never had them at all. Soluble aspirin was the preparation of salicylates most frequently prescribed (for 63 patients). Only 60 patients had been given an adequate dose and only 62 an adequate course of treatment with salicylates. In 28 patients salicylates had been stopped on account of side effects. About one-third of the patients had been prescribed oral corticosteroids.The referral letters were poor in giving details of past and present drug therapy, and there were serious omissions in reporting of previous side effects.Seventy-five general practitioners were asked to rate several currently marketed antirheumatic drugs in terms of effectiveness. Though prednisolone 15 mg daily ranked higher than aspirin 4 g daily the difference was not significant. The study shows the inadequacies of drug prescribing for rheumatoid arthritis in the Glasgow area.
Publisher: Wiley
Date: 10-2000
DOI: 10.1046/J.1440-1746.2000.02267.X
Abstract: Non-steroidal anti-inflammatory drug (NSAID) toxicity in the upper gastrointestinal tract is the most common serious drug-induced toxicity reported to drug regulatory authorities. In the last two decades, the rediscovery of H. pylori, development of potent ulcer-healing drugs and specific Cox-II inhibitors have opened new horizons in the management of NSAID toxicity. A Working Party composed of gastroenterologists and rheumatologists in the Asia-Pacific region met in Cairns, Australia, in 1999 to review the literature and develop appropriate guidelines. Recommendations were made based on the latest existing evidence. The importance of clinical events as study endpoints was emphasized. While differences exist between NSAIDs and aspirin, most studies have shown that advanced age, history of peptic ulcer disease, serious concomitant illnesses and coprescription of NSAID/aspirin with anticoagulants and steroids are high risk factors. These patients should be considered for prophylactic anti-ulcer therapy. Helicobacter pylori infection may aggravate the toxicity of NSAIDs and, in selected cases, should be treated before NSAID/aspirin is prescribed. Proton pump inhibitors and misoprostol are the most promising agents in preventing gastric and duodenal ulcers. When NSAID/aspirin needs to be continued in patients who develop an NSAID-related ulcer, proton pump inhibitors offer the best healing effect. With the discovery of cyclo-oxygenase isoforms (Cox-I and Cox-II), preferential and specific Cox-II inhibitors have been developed. While early clinical data have suggested promising antiinflammatory effects and improved safety profile in the gastrointestinal tract, several key issues on long-term safety remain unresolved. The use of potent anti-ulcer therapy, treatment of H. pylori infection and the development of Cox-II inhibitor will change the scenario of NSAID/aspirin-related gastrointestinal toxicity in the next millennium.
Publisher: Springer Science and Business Media LLC
Date: 09-1997
DOI: 10.1007/S10787-997-0006-9
Abstract: A study was designed to assess the effects of a standardized instructional videotape on reducing interobserver variability for several commonly used observer dependent outcome measures. During a single day, six rheumatologists independently examined six patients with osteoarthritis (OA) in a predetermined order using a Latin square design, before and after viewing a standardized videotape demonstrating 13 examination techniques. Reliability coefficients were calculated based on variance components of the analysis of variance (ANOVA) table. Prestandardization reliability coefficients were >0.80 for all measures and remained above 0.80 following the intervention. It is usually assumed that serial measurement in clinical trials should be performed by the same assessor because of concern regarding interobserver variability. However, the high levels of prestandardization interobserver reliability observed in this study indicate that, for these variables, serial measurements in a clinical trial could be made by different assessors, assuming they were equally skilled. This observation has important implications for outcome measurement in OA clinical trials. Although high levels of prestandardization reliability precluded the demonstration of any significant improvement, we speculate that the videotape might be effective in training less-experienced assessors. Reductions in observer variability have the potential to diminish s le size requirements for OA antirheumatic drug studies. The use of a videotape to achieve this goal offers cost and convenience advantages over one-on-one training procedures, and this method should be further assessed in less-experienced assessors.
Publisher: Oxford University Press (OUP)
Date: 15-11-2005
DOI: 10.1093/RHEUMATOLOGY/KEI114
Abstract: To explore the relationship between measures of self-efficacy, health locus of control, health status and direct medical expenditure among community-dwelling subjects with rheumatoid arthritis (RA) and osteoarthritis (OA). This analysis is part of a larger ongoing study of the costs and outcomes of arthritis and its treatments. Community-dwelling RA and OA respondents completed questionnaires concerning arthritis-related expenditure, health status, arthritis related self-efficacy and health locus of control. Data were obtained from 70 RA respondents and 223 OA respondents. The majority of respondents were female with a mean age of 63 yr for RA respondents and 68 yr for OA respondents. Among the RA respondents, those with higher self-efficacy reported better health status and lower overall costs. Health locus of control was not consistently correlated with health status. OA respondents with higher self-efficacy reported better health status and lower costs. Health locus of control had more influence. OA respondents with higher external locus of control reported worse pain and function. A higher belief in chance as a determinant of health was correlated with more visits to general practitioners and a higher cost to both the respondent and the health system. Higher self-efficacy, which is amenable to change through education programmes, was associated with better health status and lower costs to the respondent and the health system in this cross-sectional study. Locus of control had less of an influence however, the tendency was for those with higher external locus of control to have higher costs and worse health status. As the measurement of these constructs is simple and the outcome potentially affects health status, these results have implications for future intervention studies to improve quality of life and reduce the financial impact of arthritis on both the health-care system and patients.
Publisher: Wiley
Date: 2001
DOI: 10.1002/1529-0131(200106)45:3<301::AID-ART264>3.0.CO;2-I
Publisher: Elsevier BV
Date: 06-2021
Publisher: Elsevier BV
Date: 08-1986
DOI: 10.1016/S0002-9343(86)80012-2
Abstract: A single-blind endoscopic study was undertaken to test the relative efficacy of enprostil, a synthetic analogue of prostaglandin E2, cimetidine, and sucralfate in the prevention of aspirin-induced gastroduodenal mucosal injury. Fifty healthy, non-smoking male volunteers completed the study after having been randomly assigned to receive two weeks of therapy with one of the following regimens: enprostil 35 micrograms twice daily enprostil 35 micrograms in the morning cimetidine 200 mg three times daily and 400 mg at night sucralfate 1 g four times daily or placebo. In the second week, aspirin (900 mg three times daily) was also administered. Endoscopies were performed before and after the aspirin phase of the study, and lesions (mucosal erosions plus submucosal hemorrhages) were counted in the stomach and duodenal bulb. All treatments were superior to placebo (p less than 0.05). The mean number of lesions in the 70-micrograms enprostil group (8.5) was significantly less than in the 35-micrograms enprostil group, (11.1), the sucralfate group (12.4), or the placebo group (16.0) the benefit over cimetidine (10.1), however, was not statistically significant. The protective effect of enprostil was greatest in the antrum, the site of maximal mucosal injury. Gastrointestinal side effects were reported in all groups, though abdominal pain and dyspepsia were noted more frequently in those taking enprostil.
Publisher: AMPCo
Date: 02-1973
Publisher: AMPCo
Date: 04-2009
DOI: 10.5694/J.1326-5377.2009.TB02492.X
Abstract: Successful transition of students to competent work-ready health professionals requires an ability to work in health care teams. Poor communication and teamwork practice has been implicated as a contributing source of error affecting patient safety. Traditional university curriculum structures severely limit the time that students from different professions can spend together, learning about and from each other (interprofessional education [IPE]). IPE initiatives need to focus on whole-of-system impacts and organisational sustainability. The Health Care Team Challenge (HCTC) is a high-profile leadership strategy that engages students, academic staff, practising professionals, policymakers and industry in a whole-of-system approach to IPE and interprofessional practice. Interprofessional student teams compete at a live public event for a cash prize for the best management plan centred on a complex clinical case study. National and international HCTCs are planned for future years.
Publisher: BMJ
Date: 08-1983
DOI: 10.1136/ARD.42.4.439
Abstract: The anti-inflammatory effect of single doses and combinations of aspirin and commonly used nonsteroidal anti-inflammatory drugs was investigated by the polyurethane sponge implantation model of acute inflammation. Dose response curves were performed to delineate a suppressive (high) and nonsuppressive (low) dose of each drug prior to studying these doses in combination with aspirin. The results suggest that a combination of aspirin in either high or low dose does not increase the anti-inflammatory effect of other nonsteroidal anti-inflammatory drugs in this model of inflammation.
Publisher: BMJ
Date: 08-1976
DOI: 10.1136/ARD.35.4.339
Abstract: The addition of phenobarbitone in therapeutic dosage to the drug regimen of prednisolone-treated subjects with rheumatoid arthritis produced measurable deterioration in the clinical status of the patients associated with a more rapid clearance of prednisolone from plasma. It is considered that phenobarbitone induced the hepatic metabolism of prednisolone, effectively reducing the steady state plasma level and resulting in clinical relapse. A slight but significant improvement in the adrenocortical response to tetracosactrin (Synacthen) was noted after phenobarbitone therapy.
Publisher: Springer Science and Business Media LLC
Date: 16-08-2018
Publisher: Elsevier BV
Date: 10-1992
DOI: 10.1016/0006-2952(92)90471-T
Abstract: The effects of the chondroprotective drugs, sodium pentosan polysulphate (SP54) and Arteparon (glycosaminoglycan polysulphate), on the in vitro activities of the purified matrix metalloproteinases interstitial collagenase (matrix metalloproteinase 1, MMP1) and stromelysin (MMP3) were examined. Both drugs produced concentration-dependent enhancement of the degradation of type I collagen fibrils by purified human fibroblast collagenase and rat tumour collagenase. Rat collagenase activity was increased by drug concentrations above 0.5 microgram/mL, whereas human collagenase activity was only increased by higher drug concentrations, above 5 micrograms/mL. The concentration dependence of the increase in rat collagenase activity was similar for both drugs, with a maximal 3-fold increase at 50 micrograms/mL. In contrast, human collagenase activity was increased to a greater extent by SP 54 compared to Arteparon, with maximal increases at 5000 micrograms/mL of 6-fold and 2-4-fold, respectively. Both drugs produced concentration-dependent inhibition of the proteoglycan-degrading activity of both human fibroblast stromelysin and rat tumour stromelysin. Rat and human stromelysin activities were inhibited at drug concentrations above 0.005 microgram/mL, with a similar concentration dependence for both drugs. Fifty percent inhibition of rat stromelysin was produced by concentrations of each drug in the 0.5-5 microgram/mL range. The pattern of inhibition of human stromelysin was similar, except that drug concentrations in the 500-5000 micrograms/mL range produced 50% inhibition. The possible modes of action for these drug effects and their possible pharmacological significance are discussed.
Publisher: Wiley
Date: 11-1978
Publisher: BMJ
Date: 12-07-1975
Abstract: Plasma profiles of indomethacin after a 50-mg oral dose were constructed in six healthy volunteers before and after a week of aspirin treatment. Aspirin did not interfere with indomethacin plasma levels. To examine the clinical effect of concurrent indomethacin and aspirin treatment 20 patients with seropositive rheumatoid arthritis were given indomethacin 100 mg/day, aspirin soluble 4 g/day, and the two drugs taken together in random order. Analysis of the clinical indices of inflammation--articular index and mean pain score--and of the efficacy of each treatment showed no significant differences between the three treatment groups. With the proliferation in the number of anti-rheumatic drugs available, the case for giving two or more nonsteroidal anti-inflammatory drugs concurrently remains unproved.
Publisher: Elsevier BV
Date: 12-2012
Publisher: Wiley
Date: 29-10-2004
Publisher: Springer Science and Business Media LLC
Date: 08-1983
DOI: 10.1007/BF00543800
Abstract: The global prevalence of dementia is growing rapidly, driving an increased use of residential long-term care (LTC) services. Performance indicators for residential LTC should support targeting of limited resources to promote person-centered care, health, and well-being for both patients and caregivers (formal and informal), yet many performance indicators remain focused on structure, process, or outcome measures that are only assumed to support personally relevant outcomes for those with dementia, without direct evidence of meaningfulness for these in iduals. In this article, two complementary approaches to assessing quality in residential LTC serve as a lens for examining a series of tensions related to assessment in this setting. These include measurement-focused approaches using generic psychometrically valid instruments, often used to monitor quality of services, and meaning-focused approaches using in idual subjective assessment of personally relevant outcomes, often used to monitor care planning. Ex les from the European and U.S. literature suggest an opportunity to strengthen an emphasis on personally meaning-focused outcomes in quality assessment.
Publisher: Wiley
Date: 25-04-2011
Publisher: Oxford University Press (OUP)
Date: 1994
DOI: 10.1093/RHEUMATOLOGY/33.8.754
Abstract: A longitudinal study of 75 young women (median age 43 yr) with early RA was performed with psychological, clinical and functional status measured every 4 months for up to 44 months. The aim was to describe functional changes, and to estimate the association between psychosocial variables and function in the early years after diagnosis. Function was measured by the Stanford Health Assessment Questionnaire (HAQ) and improved on average by about 10% per year with most improvement occurring over the first year. Pain and psychosocial variables also improved over time. There was still a residual improvement in HAQ with time of about 4% per year not accounted for by changes in these measured variables. When examined over time, psychosocial variables were as important as disease and pain in determining function. The results suggest interventions based on the importance of maintaining social relationships could impact on function.
Publisher: The Journal of Rheumatology
Date: 08-2017
Abstract: The aim of this Outcome Measures in Rheumatology (OMERACT) Working Group was to determine the core set of outcome domains and subdomains for measuring the effectiveness of shared decision-making (SDM) interventions in rheumatology clinical trials. Following the OMERACT Filter 2.0, and based on a previous literature review of SDM outcome domains and a nominal group process at OMERACT 2014, (1) an online Delphi survey was conducted to gather feedback on the draft core set and refine its domains and subdomains, and (2) a workshop was held at the OMERACT 2016 meeting to gain consensus on the draft core set. A total of 170 participants completed Round 1 of the Delphi survey, and 116 completed Round 2. Respondents came from 29 countries, with 49% being patients/caregivers. Results showed that 14 out of the 17 subdomains within the 7 domains exceeded the 70% criterion (endorsement ranged from 83% to 100% of respondents). At OMERACT 2016, only 8% of the 96 attendees were patients/caregivers. Despite initial votes of support in breakout groups, there was insufficient comfort about the conceptualization of these 7 domains and 17 subdomains for these to be endorsed at OMERACT 2016 (endorsement ranged from 17% to 68% of participants). Differences between the Delphi survey and consensus meeting may be explained by the manner in which the outcomes were presented, variations in participant characteristics, and the context of voting. Further efforts are needed to address the limited understanding of SDM and its outcomes among OMERACT participants.
Publisher: BMJ
Date: 03-1988
DOI: 10.1136/ARD.47.3.241
Abstract: Monosodium urate (MSU) crystals induce an inflammatory response when injected into the rat subcutaneous air pouch, which is characterised by polymorphonuclear leucocyte (PMNL) accumulation and plasma leakage. The arachidonic acid metabolites leucotriene B4 (LTB4), prostaglandin E2 (PGE2), 6-oxo-prostaglandin F1 alpha, (6-oxo-PGF1 alpha), and thromboxane B2 (TXB2) are found in increased concentrations in MSU induced exudates compared with animals injected with phosphate buffered saline (PBS). Pretreatment of animals with BW 755c significantly reduced the concentration of both lipoxygenase and cyclo-oxygenase derived arachidonic acid metabolites. Although BW 755c reduced MSU crystal induced plasma leakage, it did not affect PMNL accumulation. Pretreatment of animals with indomethacin selectively inhibited the generation of cyclo-oxygenase derived arachidonic acid metabolites and reduced MSU crystal induced plasma leakage but had no effect on PMNL accumulation. The inhibition of plasma leakage by either BW 755c or indomethacin was reversed by prostaglandin E2 (1 microgram/ml), which itself produced a significant increase in plasma leakage. The injection of purified LTB4 (4 ng/ml or 40 ng/ml) did not induce either plasma leakage or PMNL accumulation within the air pouch. These data suggest that although MSU crystals stimulate LTB4 production, LTB4 is not the mediator of MSU crystal induced PMNL accumulation. Cyclo-oxygenase products of arachidonic acid metabolism (e.g., PGE2), however, appear to play a part in MSU crystal induced plasma leakage.
Publisher: Wiley
Date: 12-1998
DOI: 10.1046/J.1365-2141.1998.01073.X
Abstract: High-dose chemotherapy with autologous stem cell rescue has been proposed as an intensive therapy for severe rheumatoid arthritis (RA). In view of previous observations of abnormal haemopoiesis in RA patients, the composition and function of peripheral blood stem cell harvests (PBSCH) was investigated. Compared with PBSCH from healthy allogeneic donors mobilized with the same dose of G-CSF (filgrastim 10 microg/kg/d, n = 14), RA PBSCH (n = 9) contained significantly fewer mononuclear cells (375 v 569 x 10(6)/kg, P = 0.03) and CD34+ cells (2.7 v 5.8 x 10(6)/kg, P = 0.003). However, there were increased proportions of CD14+ cells (P = 0.006) and CD14+ CD15+ cells (the phenotype of previously described 'abnormal' myeloid cells, P = 0.002) in the RA PBSCH which translated into 3.5- and 7-fold increases respectively on a per CD34+ cell basis. There were no differences in T-cell activation status as judged by proportions of CD4+ and CD8+ expressing CD45RA, CD45RO, HLA-DR and CD28 (RA PBSCH, n = 7, donor PBSCH, n = 5, P = 0.2-0.7). Phytohaemagglutinin responses determined fluorocytometrically with induction of CD69 expression were reduced in CD4+ and CD8+ cells following filgrastim administration in 3/3 RA patients tested. Compared with bone marrow as a potential source of CD34+ cells, PBSCH contained 11-fold more T cells (P < 0.0005), 8-fold more B cells (P < 0.0005) and 4-fold more monocytes (P = 0.02). In short-term methylcellulose culture there were no differences in colony counts (CFU-GM, CFU-GEMM, BFU-E) per CD34+ cell from PBSCH from RA patients (n = 11) and healthy donors (n = 10). Long-term culture initiator cells were cultured successfully from cryopreserved PBSCH from RA patients (n = 9). In conclusion, PBSCH from RA patients differed significantly in composition from normal in iduals, but in vitro studies support normal stem and progenitor cell function. Changes in T-cell function occur during mobilization in RA patients. This work provides reassurance for the use of PBSCH as haematological rescue and baseline data for clinical trials of graft manipulation strategies in patients with RA.
Publisher: Wiley
Date: 12-1974
Publisher: Elsevier BV
Date: 08-2015
Publisher: BMJ
Date: 22-08-2011
DOI: 10.1136/BMJ.D5006
Publisher: Springer Science and Business Media LLC
Date: 03-1998
DOI: 10.1007/S10787-998-0009-1
Abstract: To compare methodological aspects of the impact of different classification procedures used in three phases of a twin study examining genetic factors in the aetiopathogenesis of rheumatoid arthritis (RA). We have previously reported the results of a study of the aetiopathogenesis of RA based on the Australian Twin Registry (ATR). In the original 258 pairs self-reporting a diagnosis of RA in twin, co-twin or both, a very high false positive self-reporting rate for RA was noted (Phase 1). Subsequent diagnostic information obtained by a disease-specific questionnaire, followed by telephone interviews with subjects and review of information obtained by mail and telephone interview from the patient's general practitioner or musculoskeletal specialist, identified 23 'true' RA pairs (Phase 2). Pairwise concordance percentages for RA based on those 20 discordant and 3 concordant pairs were as follows: monozygotic (MZ) 21% (95% confidence interval (CI)=6-44%), dizygotic (DZ) 0% (95% CI=0-25%) (probandwise concordance MZ 35% (8.9-67.3), DZ 0% (0-50.3)). Given the potential effects of misclassification on data interpretation, we have further pursued the accuracy of diagnosis by a systematic clinical, serological and radiographical evaluation of the 23 RA pairs (Phase 3). In only one instance did more intense diagnostic investigation of the 23 pairs result in recategorization. The probandwise concordance percentages were recalculated: MZ=37.5%, DZ=0%. Our original contention that genetic factors play some part in the aetiopathogenesis of RA, but do not account entirely for its determination, has been substantiated at a higher level of confidence and at almost identical levels of concordance.
Publisher: BMJ
Date: 22-10-1994
DOI: 10.1136/BMJ.309.6961.1041
Abstract: To evaluate the efficacy of paracetamol and a non-steroidal anti-inflammatory drug for symptom relief in osteoarthritis. Double blind, randomised, controlled trials in in idual patients (n of 1 trials). Three treatment cycles with two weeks' each of paracetamol (1 g twice daily) and diclofenac (50 mg twice daily) prepared in identical gelatin capsules. General practices in metropolitan Sydney, Australia. 25 patients (median age 64 years) with pain of osteoarthritis (median duration of disease eight years) considered by their general practitioners to require regular treatment. 20 were already taking non-steroidal anti-inflammatory drugs. Diary of pain and stiffness, function, and side effects. 15 patients completed the study, five withdrew early but had made a therapeutic decision, and five dropped out very early. Results from 20 patients were analysed. Several patterns of response evolved. Eight of the 20 patients found no clear difference, symptoms being adequately controlled by paracetamol five indicated a clear preference for the non-steroidal anti-inflammatory drug two showed control of symptoms after their initial two weeks of the non-steroidal anti-inflammatory drug which continued throughout subsequent treatment changes in five the non-steroidal anti-inflammatory drug may have been better but neither agent gave satisfactory control. After three months nine of the 20 patients had adequate symptom control with paracetamol alone. Of 1 studies--that is, randomised trials in in idual patients--are clinically useful in deciding treatment in heterogeneous conditions which require long term symptomatic relief. In osteoarthritis many patients currently receiving or being considered for non-steroidal anti-inflammatory drugs may achieve adequate control with paracetamol.
Publisher: Wiley
Date: 10-1984
DOI: 10.1111/J.1445-5994.1984.TB05019.X
Abstract: A group of hospital patients aged 55 years or over (53 men, 74 women) were screened for articular chondrocalcinosis (ACC) with high-resolution radiographs of knees, wrists, hand and pelvis. Two men (4%) aged 79 and 86 years had ACC involving knees, wrists and symphysis pubis. Both had clinical joint disease and radiological osteoarthritis (OA). Eighteen women (24%) had ACC with sites affected including the knees (89%), wrists (39%) and symphysis pubis (44%). Metabolic screening did not reveal any predisposing factors in patients with ACC. Symptoms and signs of joint disease were not significantly more common in women with ACC compared to those without ACC, and 44% of those with knee calcification were clinically asymptomatic and had no evidence of OA radiologically. However, the presence of knee ACC significantly increased the risk for OA in the same knee by a factor of three-to-four while knee calcification was associated with the more severe grades of radiographic OA.
Publisher: Oxford University Press (OUP)
Date: 1982
DOI: 10.1093/RHEUMATOLOGY/21.2.95
Abstract: Sixty-two patients with osteoarthrosis entered a 10-week double-blind cross-over trial of diflunisal and naproxen. Eight patients withdrew for drug-related reason, and seven for other reasons. There was no statistically significant difference in parameters of disease activity on each treatment period, but naproxen produced fewer withdrawals due to drug-related side-effects.
Publisher: Springer Science and Business Media LLC
Date: 1988
DOI: 10.1007/BF00542502
Abstract: To increase the in-plane spatial resolution and image update rates of 2D magnetic resonance (MR) digital subtraction angiography (DSA) pulse sequences to 0.57 × 0.57 mm and 6 frames/sec, respectively, for intracranial vascular disease applications by developing a radial FLASH protocol and to characterize a new artifact, not previously described in the literature, which arises in the presence of such pulse sequences. The pulse sequence was optimized and artifacts were characterized using simulation and phantom studies. With Institutional Review Board (IRB) approval, the pulse sequence was used to acquire time-resolved images from healthy human volunteers and patients with x-ray DSA-confirmed intracranial vascular disease. Artifacts were shown to derive from inhomogeneous spoiling due to the nature of radial waveforms. Gradient spoiling strategies were proposed to eliminate the observed artifact by balancing gradient moments across TR intervals. The resulting radial 2D MR DSA sequence (2.6 sec temporal footprint, 6 frames/sec with sliding window factor 16, 0.57 × 0.57 mm in-plane) demonstrated small vessel detail and corroborated x-ray DSA findings in intracranial vascular imaging studies. Appropriate gradient spoiling in radial 2D MR DSA pulse sequences improves intracranial vascular depiction by eliminating circular banding artifacts. The proposed pulse sequence may provide a useful addition to clinically applied 2D MR DSA scans.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2018
DOI: 10.1007/S00586-018-5725-7
Abstract: The purpose of this report is to describe the development of a list of resources necessary to implement a model of care for the management of spine-related concerns anywhere in the world, but especially in underserved communities and low- and middle-income countries. Contents from the Global Spine Care Initiative (GSCI) Classification System and GSCI care pathway papers provided a foundation for the resources list. A seed document was developed that included resources for spine care that could be delivered in primary, secondary and tertiary settings, as well as resources needed for self-care and community-based settings for a wide variety of spine concerns (e.g., back and neck pain, deformity, spine injury, neurological conditions, pathology and spinal diseases). An iterative expert consensus process was used using electronic surveys. Thirty-five experts completed the process. An iterative consensus process was used through an electronic survey. A consensus was reached after two rounds. The checklist of resources included the following categories: healthcare provider knowledge and skills, materials and equipment, human resources, facilities and infrastructure. The list identifies resources needed to implement a spine care program in any community, which are based upon spine care needs. To our knowledge, this is the first international and interprofessional attempt to develop a list of resources needed to deliver care in an evidence-based care pathway for the management of people presenting with spine-related concerns. This resource list needs to be field tested in a variety of communities with different resource capacities to verify its utility. These slides can be retrieved under Electronic Supplementary Material.
Publisher: Hindawi Limited
Date: 10-1976
Publisher: Wiley
Date: 1980
DOI: 10.1111/J.1365-2125.1980.TB04794.X
Abstract: 1. The effects of chronic administration of aspirin in therapeutic doses (3.9 g/day) on plasma and salivary salicylate levels were studied in eight subjects. 2. The urinary excretion profile for free salicylic acid and metabolites of salicylate were examined. 3. Plasma and salivary salicylate levels declined significantly after peak levels were achieved between days 3 and 10. 4. The decline in plasma and salivary salicylate levels may be due to an induction of a metabolic pathway such as salicylurate formation (Furst, Gupta & Paulus, 1977). Only the mean fraction of salicylate excreted as salicylurate appears to increase with time during the present study, although the change was not significant statistically. 5. The decline in plasma and salivary salicylate levels during chronic therapy may lead to an apparent 'tolerance' of some rheumatoid patients to aspirin.
Publisher: Informa UK Limited
Date: 1984
DOI: 10.3109/03009748409100373
Abstract: Reliability in the assessment of radiographic abnormalities in the sacro-iliac joint was investigated by rheumatologists and radiologists experienced in the reading of such films. This study differs from previous ones in that films were masked to reduce cueing from the radiographic appearance of other pelvic bone and joint structures. Agreement was greatest (greater than or equal to 80%) when only the presence or absence of abnormality was considered. When corrected for chance, agreement on the in idual radiographic abnormalities was frequently poor or modest. The use of reference radiographs reduced absolute disagreement and had a modest influence on absolute agreement. The scoring of films for epidemiologic purposes should preferably be delegated to senior radiologists using standard reference films. Nevertheless, there remains a considerable margin of error in the interpretation of sacroiliac joint radiographs which is of clinical and epidemiological importance considering the weight that radiographs of this joint carry in diagnostic rheumatology.
Publisher: Wiley
Date: 12-1982
DOI: 10.1111/J.1445-5994.1982.TB02652.X
Abstract: The major metabolic fates of glucose in cells are glycolysis and the pentose phosphate pathway, and they share the first step: converting glucose to glucose-6-phosphate (G6P). Here, we show that G6P can be sensed by the transcription factor MondoA/Mlx to modulate Txnip expression. Endogenous knockdown and EMSA (gel migration assay) analyses both confirmed that G6P is the metabolic intermediate that activates the heterocomplex MondoA/Mlx to elicit the expression of Txnip. Additionally, the three-dimensional structure of MondoA is modeled, and the binding mode of G6P to MondoA is also predicted by
Publisher: Wiley
Date: 08-1983
DOI: 10.1111/J.1440-1681.1983.TB00845.X
Abstract: Indomethacin is still used commonly for the treatment of rheumatic diseases but is associated with side effects, particularly headache, in a number of patients. A controlled or sustained release formulation of indomethacin might provide lower peak plasma levels and thus reduce side effects while still maintaining adequate plasma levels to control pain and inflammation. In this single dose crossover study, normal volunteers received the new formulation of indomethacin (Indocid GITS 6/85) fasting or with a standard meal, indomethacin 75 mg with a standard meal or indomethacin 25 mg three times daily with a standard meal. Plasma concentration data showed that peak plasma levels were reduced but the area under the plasma concentration curve was not significantly different between the four treatments.
Publisher: The Journal of Rheumatology
Date: 09-2009
Abstract: Due to mounting concern about determination of benefit and risk in the context of product development and clinical practice the OMERACT Executive identified the need to bring together a variety of specialists to define risk. At the Drug Safety Summit held at OMERACT 9, specialists spoke on their given topics and the group considered risk in the context of formally posed questions.
Publisher: Wiley
Date: 12-1988
DOI: 10.1111/J.1445-5994.1988.TB01647.X
Abstract: A 72-year-old female with a recent episode of podagra, without peripheral tophi, presented with nocturnal back pain and a destructive lesion of the right lamina of L4. A tophus was excised at laminectomy. Evidence of an axial skeletal tophus causing an irritative radiculopathy via mass effect is presented.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.BERH.2012.03.004
Abstract: Musculoskeletal diseases continue to produce major disability around the world. Advances in therapy - particularly for the inflammatory diseases - have the potential to eradicate the inflammation and thus prevent joint destruction. Surgical advances include minimally invasive and computer-assisted robotic surgery, and advances in arthroscopic surgery. The development of new musculoskeletal tissues - tendons, cartilage and bone using nanotechnology and stem cells - has the potential to revolutionise the way we approach these chronic destructive diseases as well as major trauma. With the rapid increase in these conditions with an ageing population, new models of care will need to be developed to ensure that the right care is delivered at the right time by the most appropriately trained health professional and at a reasonable cost. The Bone and Joint Decade has played a significant role in focussing researchers, clinicians and health educators on these diseases and also in drawing them to the attention of Governments around the globe. While there is still much to be done, the journey has commenced and will continue into the future with education, research and service delivery into these important conditions being further enhanced.
Publisher: Elsevier BV
Date: 04-2012
DOI: 10.1016/J.BERH.2012.03.002
Abstract: Musculoskeletal (MSK) disorders are among the leading reasons why patients consult a family or primary health practitioner, take time off work and become disabled. Many of the MSK disorders are more common in the elderly. Thus, as the proportion of the elderly increases all over the world, MSK disorders will make a greater contribution to the global burden of disease. Epidemiological studies have shown that the spectrum of MSK disorders in developing countries is similar to that seen in industrialised countries, but the burden of disease tends to be higher due to a delay in diagnosis or lack of access to adequate health-care facilities for effective treatment. Musculoskeletal pain is very common in the community while fibromyalgia is being recognised as part of a continuum of chronic widespread pain rather than a narrowly defined entity. This will allow research to improve our understanding of pain in a variety of diffuse pain syndromes. The availability of newer more effective therapies has resulted in efforts to initiate therapy at an earlier stage of diseases. The new criteria for rheumatoid arthritis, and the diagnosis of axial and peripheral involvement in spondyloarthritis, permit an earlier diagnosis without having to wait for radiological changes. One of the major health challenges is the global shortage of health workers, and based on current training of health workers and traditional models of care for service delivery, the global situation is unlikely to change in the near future. Thus, new models of care and strategies to train community health-care workers and primary health-care practitioners to detect and initiate the management of patients with MSK disorders at an earlier stage are required. There is also a need for prevention strategies with c aigns to educate and raise awareness among the entire population. Lifestyle interventions such as maintaining an ideal body weight to prevent obesity, regular exercises, avoidance of smoking and alcohol abuse, intake of a balanced diet and nutrients to include adequate calcium and vitamin D, modification of the work environment and avoidance of certain repetitive activities will prevent or ameliorate disorders such as osteoarthritis, osteoporosis, rheumatoid arthritis, gout and MSK pain syndromes including low back pain and work-related pain syndromes. These prevention strategies also contribute to reducing the prevalence and outcome of diseases such as hypertension, cardiovascular diseases, diabetes and respiratory diseases. Thus, prevention strategies require urgent attention globally.
Publisher: SAGE Publications
Date: 12-2007
DOI: 10.1258/135763307783247383
Abstract: Over a two-year period, eight medical students from four U21 universities spent their electives at hospitals in Pakistan, Papua New Guinea and Sri Lanka. They made a total of 49 e-referrals which resulted in 67 queries in a wide range of specialties. The median response time was 20 h (interquartile range 5–85). Follow-up data were obtained in 14 of the 30 cases from one hospital (47%). The major categories of the 67 queries were internal medicine, paediatrics and surgery, and in very similar proportions to the 785 queries managed by the Swinfen Charitable Trust over the same period. The presence of a medical student facilitated e-referrals by relieving the pressure on the local doctor to undertake the necessary clerical and technical work. The students reported a rewarding elective experience which appears to have the potential to increase the ease with which heavily burdened medical staff in developing countries can make use of e-referrals.
Publisher: American Medical Association (AMA)
Date: 20-02-1978
Publisher: Wiley
Date: 02-1988
DOI: 10.1111/J.1445-5994.1988.TB02236.X
Abstract: Forty-five patients with acromegaly or gigantism were reviewed for musculoskeletal abnormalities. Abnormalities of peripheral joints occurred in 74% of the patients and spinal involvement in 47%, leading to significant morbidity. Joint abnormalities most frequently affected the large joints (hips, knees and shoulders) but the wrist and hand were also involved. The radiological features of acromegalic arthropathy are described, including vertical widening of the hip joint, enthesopathy and osteophytosis. A favourable response to treatment is associated with a less severe arthropathy and a good functional outcome.
Publisher: The Journal of Rheumatology
Date: 09-2009
Abstract: There is great concern about clearly defining benefit and risk in the context of both drug development and clinical practice. In view of this pressure, the OMERACT Executive identified the need to bring together clinical trialists, pharmacoepidemiologists, clinicians, clinical epidemiologists, statistical experts, and regulatory representatives to discuss different approaches to define risk and perhaps improved ways to express it. Each attendee spoke on a given topic and the group was charged to consider the issue of risk in the context of formally posed questions. This article provides a summary of the presentations and outlines the discussions that followed.
Publisher: Elsevier BV
Date: 1983
DOI: 10.1016/S0378-4347(00)84347-9
Abstract: A high-performance liquid chromatographic assay for penicillamine in plasma is described. The method is based on the derivatisation of penicillamine in acidified protein-free plasma supernatants with the sulphydryl-specific reagent N-[p-(2-benzoxazolyl)-phenyl] maleimide (BOPM) to give a stable fluorescent product. After separation of the penicillamine-BOPM derivative by reversed-phase high-performance liquid chromatography, fluorescence detection enables the quantitation of plasma penicillamine concentrations in the range 0.25-500 mumol/l. The method is selective and reproducible, and since chromatography time is less than 7 min the method is readily applicable to the analysis of the large number of s les associated with pharmacokinetic studies.
Publisher: BMJ
Date: 08-1992
DOI: 10.1136/ARD.51.8.946
Abstract: Interleukin 1 (IL-1), IL-6, and tumour necrosis factor (TNF) alpha are pleiotropic cytokines produced predominantly by macrophages which have been implicated in the pathogenesis of rheumatoid arthritis (RA). Sulphasalazine has been shown to have disease modifying properties and to inhibit the production of cytokines in vitro. To evaluate the effect of sulphasalazine on cytokine production in vivo, serum cytokine levels were measured in a group of patients with RA entered into a randomised controlled trial. Serum levels of IL-1 alpha, IL-1 beta, IL-6, and TNF alpha were measured at baseline and at two monthly intervals for six months in 17 patients receiving sulphasalazine and in 22 patients treated with placebo. The two groups of patients had a similar age and sex distribution, had had RA for less than a year, had no joint erosions, and had not been treated previously with any other disease modifying drugs. In the 39 patients studied IL-1 alpha was detected (> 0.1 ng/ml) at baseline in 14 patients (median 0.24 ng/ml), IL-1 beta in 25 patients (median 1.0 ng/ml), TNF alpha in 27 patients (median 1.2 ng/ml), and IL-6 in 33 patients (median 0.44 ng/ml). In the group treated with sulphasalazine there was a progressive and significant decline in serum IL-1 alpha, IL-1 beta, and TNF alpha levels over the six month period (median levels at six months were < 0.1, 0.12, and 0.44 ng/ml respectively). Interleukin 6 levels were significantly reduced only at the four month time point (median level of 0.23 ng/ml). These reductions were associated with improvements in clinical and laboratory measures of disease activity. In contrast patients receiving the placebo showed no changes in serum cytokine levels and no improvement in clinical and laboratory indices of disease activity. These results suggest that sulphasalazine may exert its disease modifying effect partly by suppressing cytokine production in vivo.
Publisher: Wiley
Date: 11-1989
DOI: 10.5694/J.1326-5377.1989.TB128510.X
Abstract: We recently have conducted a cross-sectional survey to determine the prescribing practices of rheumatologists and a random s le of general practitioners in New South Wales and Queensland. While in general there was agreement as to the preferred management of gout, several important differences were noted between the two groups of doctors. In particular, general practitioners were more liberal than were rheumatologists in their use of allopurinol. However, they were less likely to cover the introduction of allopurinol with anti-inflammatory agents, to titrate the dose against the serum uric acid level or to adjust the dose according to the serum creatinine level. A small number of doctors continued to use urate-lowering drugs as a routine in the treatment of entirely asymptomatic hyperuricaemia. The data indicate a continuing need to disseminate information regarding the preferred management of hyperuricaemic states.
Publisher: AMPCo
Date: 09-2004
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.BERH.2010.10.002
Abstract: Low back pain is an extremely common problem that most people experience at some point in their life. While substantial heterogeneity exists among low back pain epidemiological studies limiting the ability to compare and pool data, estimates of the 1 year incidence of a first-ever episode of low back pain range between 6.3% and 15.4%, while estimates of the 1 year incidence of any episode of low back pain range between 1.5% and 36%. In health facility- or clinic-based studies, episode remission at 1 year ranges from 54% to 90% however, most studies do not indicate whether the episode was continuous between the baseline and follow-up time point(s). Most people who experience activity-limiting low back pain go on to have recurrent episodes. Estimates of recurrence at 1 year range from 24% to 80%. Given the variation in definitions of remission and recurrence, further population-based research is needed to assess the daily patterns of low back pain episodes over 1 year and longer. There is substantial information on low back pain prevalence and estimates of the point prevalence range from 1.0% to 58.1% (mean: 18.1% median: 15.0%), and 1 year prevalence from 0.8% to 82.5% (mean: 38.1% median: 37.4%). Due to the heterogeneity of the data, mean estimates need to be interpreted with caution. Many environmental and personal factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the third decade, and overall prevalence increases with age until the 60-65 year age group and then gradually declines. Other commonly reported risk factors include low educational status, stress, anxiety, depression, job dissatisfaction, low levels of social support in the workplace and whole-body vibration. Low back pain has an enormous impact on in iduals, families, communities, governments and businesses throughout the world. The Global Burden of Disease 2005 Study (GBD 2005) is currently making estimates of the global burden of low back pain in relation to impairment and activity limitation. Results will be available in 2011. Further research is needed to help us understand more about the broader outcomes and impacts from low back pain.
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10897
Abstract: This paper assesses what health workforce ‘sustainability’ might mean for Australia and New Zealand, given the policy direction set out in the World Health Organization draft code on international recruitment of health workers. The governments in both countries have in the past made policy statements about the desirability of health workforce ‘self-sufficiency’, but OECD data show that both have a high level of dependence on internationally recruited health professionals relative to most other OECD countries. The paper argues that if a target of ‘self-sufficiency’ or sustainability were to be based on meeting health workforce requirements from home based training, both Australia and New Zealand fall far short of this measure, and continue to be active recruiters. The paper stresses that there is no common agreed definition of what health workforce ‘self-sufficiency’, or ‘sustainability’ is in practice, and that without an agreed definition it will be difficult for policy-makers to move the debate on to reaching agreement and possibly setting measurable targets or timelines for achievement. The paper concludes that any policy decisions related to health workforce sustainability will also have to taken in the context of a wider community debate on what is required of a health system and how is it to be funded.
Publisher: Wiley
Date: 09-2002
DOI: 10.1002/ART.10495
Abstract: Evidence from animal studies, case reports, and phase I studies suggests that hemopoietic stem cell transplantation (HSCT) can be effective in the treatment of rheumatoid arthritis (RA). It is unclear, however, if depletion of T cells in the stem cell product infused after high-dose chemotherapy is beneficial in prolonging responses by reducing the number of infused autoreactive T cells. This pilot multicenter, randomized trial was undertaken to obtain feasibility data on whether CD34 selection (as a form of T cell depletion) of an autologous stem cell graft is of benefit in the HSCT procedure in patients with severe, refractory RA. Thirty-three patients with severe RA who had been treated unsuccessfully with methotrexate and at least 1 other disease-modifying agent were enrolled in the trial. The patients received high-dose immunosuppressive treatment with 200 mg/kg cyclophosphamide followed by an infusion of autologous stem cells that were CD34 selected or unmanipulated. Safety, efficacy (based on American College of Rheumatology [ACR] response criteria), and time to recurrence of disease were assessed on a monthly basis for up to 12 months. All patients were living at the end of the study, with no major unexpected toxicities. Overall, on an intent-to-treat basis, ACR 20% response (ACR20) was achieved in 70% of the patients. An ACR70 response was attained in 27.7% of the 18 patients who had received CD34-selected cells and 53.3% of the 15 who had received unmanipulated cells (P = 0.20). The median time to disease recurrence was 147 days in the CD34-selected cell group and 201 days in the unmanipulated cell group (P = 0.28). There was no relationship between CD4 lymphopenia and response, but 72% of rheumatoid factor (RF)-positive patients had an increase in RF titer prior to recurrence of disease. HSCT can be performed safely in patients with RA, and initial results indicate significant responses in patients with severe, treatment-resistant disease. Similar outcomes were observed in patients undergoing HSCT with unmanipulated cells and those receiving CD34-selected cells. Larger studies are needed to confirm these findings.
Publisher: Wiley
Date: 14-09-2005
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4427441
Publisher: Elsevier BV
Date: 02-2001
Abstract: The aims of this study were to assess changes in physical function and quality of life with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the instrument of the Medical Outcomes Study SF-36 Health Survey (MOS SF-36), respectively, in patients undergoing hip anf knee joint replacement surgery and to compare the responsiveness of these two outcome measures 1 year after surgery. One hundred and ninety-four patients with osteoarthritis (OA knee 108, OA hip 86) admitted to four hospitals in Sydney were followed over a period of 1 year at 3 monthly intervals. WOMAC measures improved significantly after 1 year for OA hip and OA knee: there was reduction in pain of 71% and 53%, reduction of stiffness of 55% and 43% and improvement in physical function of 68% and 43%, respectively. MOS SF-36 measures in those having hip surgery improved significantly for pain (222%), physical function (247%), physical role functioning (402%), general health (110%), vitality (143%0, social functioning (169%) and mental health (114%). For those in the knee surgery group, significant improvement was seen for pain (175%), physical function (197%), physical role functioning (275%), vitality (125%) and social functioning (119%). The WOMAC was a more responsive measure than the MOS SF-36. WOMAC and MOS SF-36 detect significant and clinically meaningful changes in outcome after hip and knee replacement. WOMAC requires a smaller s le size and is more responsive in the short term. For a follow-up longer than 6 months MOS SF-36 provides additional information. The improvement in outcomes following hip joint surgery were significantly greater than those following knee surgery.
Publisher: Springer Science and Business Media LLC
Date: 12-1992
DOI: 10.1007/BF02755882
Publisher: Massachusetts Medical Society
Date: 04-09-1980
Publisher: BMJ
Date: 09-1989
DOI: 10.1136/ARD.48.9.733
Abstract: Synovial angiogenesis may play an important part in the destruction of articular cartilage in patients with rheumatoid arthritis (RA). As an important first step towards developing in vitro models of synovial angiogenesis, microvascular endothelial cells have been isolated, purified, and cultured from operative synovial specimens obtained from adult patients with RA.
Publisher: Wiley
Date: 1986
Abstract: Paired s les of synovial fluid (SF) and blood were obtained prior to and at 4 and 24 hours following high-dose methylprednisolone infusion therapy in a group of patients with refractory rheumatoid arthritis. After therapy there was a significant decrease in numbers of polymorphonuclear leukocytes, lymphocytes, immune complexes, and C-reactive protein in the SF. Measurement of lymphocyte subsets, using monoclonal antibodies, revealed that at 4 hours postinfusion, there was a disproportionate decrease in the percentage of SF lymphocytes expressing class II antigens (HLA-DR or Ia-like). These data suggest that glucocorticoids induce rapid changes in SF indices of disease activity and may directly influence T cell activation within the rheumatoid joint.
Publisher: Wiley
Date: 10-1980
DOI: 10.1111/J.1365-2362.1980.TB00054.X
Abstract: Transcatheter aortic valve implantation (TAVI) is still developing and changing our approach to treating patients with severe symptomatic aortic stenosis. Aortic stenosis frequently coexists with coronary artery disease. Both diseases have similar risk factors for their development and one should expect a future progression of coronary artery disease. The current guidelines have expanded TAVI indications to include intermediate-risk patients, and perhaps they will be expanded to include low-risk patients in the future. Survival after TAVI in younger patients will depend on the durability of the aortic valves and methods of coronary artery disease treatment. This paper presents some aspects of performing coronary angiography and percutaneous coronary intervention in patients who had TAVI performed using the two most popular aortic valves - balloon expandable aortic valves (Edward Sapien/Edward Sapien XT/Sapien 3) and self-expandable aortic valves (CoreValve/Evolut R) - on the basis of several ex les. This paper also focuses on technical aspects associated with a proper implantation of aortic valves to ensure easy access to coronary arteries, as well as on possible problems when the implantation is not optimal. We discuss interactions between the structure of the aortic valve stent, catheters, commissures of new aortic valves, and coronary ostia.
Publisher: Wiley
Date: 10-1976
Publisher: AMPCo
Date: 11-1976
DOI: 10.5694/J.1326-5377.1976.TB128276.X
Abstract: Eight subjects having raised triglyceride levels associated with conditions such as diabetes, hyperuricaemia, obesity and hypothyroidism were given 50 g of bran per day to determine the effect of increasing dietary fibre on triglyceride and purine metabolism. The study was continued for two months. No significant effect was noted on the serum cholesterol or triglyceride level. There was a significant (p less than 0-0125) increase in the urate clearance during the initial two weeks of bran treatment, but serum uric acid levels did not alter.
Publisher: AMPCo
Date: 02-2009
DOI: 10.5694/J.1326-5377.2009.TB02320.X
Abstract: The World Health Organization estimates a current global shortage of 4.3 million health workers. Australia and New Zealand compare unfavourably with other Organisation for Economic Co-operation and Development (OECD) countries in respect to doctor numbers. The overall shortage of doctors in Australia and New Zealand is exaggerated by the disciplinary, cultural and demographic maldistribution of the doctors relative to need and utility. Australia and New Zealand are the most reliant of the OECD countries on foreign doctors. An increase in spending on health promotion and disease prevention is essential. However, it is unlikely that the demand for doctors will be significantly reduced by compressions of morbidity in the later years of life or that there will be a substantive increase in either the percentage of the community employed in health services or in the output from the current workforce. Doctor shortages are better addressed by alignment of elements of the education and health systems with each other and with patient care needs, and by innovative health provider training and employment.
Publisher: Oxford University Press (OUP)
Date: 1988
DOI: 10.1093/RHEUMATOLOGY/27.1.7
Abstract: The longitudinal determinants of disability were studied in a group of 30 patients with rheumatoid arthritis over a 3-year period. The patients were investigated on two occasions using quantitative measures of disease activity and disability as well as a series of reliable psychometric instruments. Both longitudinal and cross-sectional data analyses were performed. Psychological factors consistently predicted more of the variance of disability than disease activity. These factors were associated with the tendency to deny the emotional dilemmas caused by having a chronic illness, difficulty in accepting doctors' reassurances and clinical depression. Such psychological variables required specific attention in rehabilitation programmes.
Publisher: Elsevier BV
Date: 1991
DOI: 10.1016/0006-2952(91)90025-Z
Abstract: To model the behavior of uveal melanoma in the liver. A 15-muL suspension of metastatic MUM2B or either primary OCM1 or M619 uveal melanoma cells was injected into the liver parenchyma of 105 CB17 SCID mice through a 1-cm abdominal incision. Animals were killed at 2, 4, 6, or 8 weeks after injection. Before euthanatization, 3% FITC-BSA buffer was injected into the retro-orbital plexus of one eye of three mice. Liver tissues were examined by light and fluorescence microscopy, and were stained with human anti-laminin. Vasculogenic mimicry patterns were reconstructed from serial laser scanning confocal microscopic stacks. OCM1a cells formed microscopic nodules in the mouse liver within 2 weeks after injection and metastasized to the lung 6 weeks later. By contrast, M619 and MUM2B cells formed expansile nodules in the liver within 2 weeks and gave rise to pulmonary metastases within 4 weeks after injection. Vasculogenic mimicry patterns, composed of human laminin and identical with those in human primary and metastatic uveal melanomas, were detected in the animal model. The detection of human rather than mouse laminin in the vasculogenic mimicry patterns in this model demonstrates that these patterns were of tumor cell origin and were not co-opted from the mouse liver microenvironment. There are currently no effective treatments for metastatic uveal melanoma. This direct-injection model focuses on critical interactions between the tumor cell and the liver. It provides for translationally relevant approaches to the development of new modalities to detect small tumor burdens in patients, to study the biology of clinical dormancy of metastatic disease in uveal melanoma, to design and test novel treatments to prevent the emergence of clinically manifest liver metastases after dormancy, and to treat established uveal melanoma metastases.
Publisher: The Journal of Rheumatology
Date: 15-02-2019
Abstract: The Outcome Measures in Rheumatology (OMERACT) Safety Working Group is identifying core safety domains that matter most to patients with rheumatic disease. International focus groups were held with 39 patients with inflammatory arthritis to identify disease-modifying antirheumatic drug (DMARD) experiences and concerns. Themes were identified by pragmatic thematic coding and discussed in small groups by meeting attendees. Patients view DMARD side effects as a continuum and consider the cumulative effect on day-to-day function. Disease and drug experiences, personal factors, and life circumstances influence tolerance of side effects and treatment persistence. Patients weigh overall adverse effects and benefits over time in relation to experiences and life circumstances.
Publisher: AMPCo
Date: 09-2012
DOI: 10.5694/MJA12.11016
Publisher: American Medical Association (AMA)
Date: 06-02-2013
Abstract: Corticosteroid injection and physiotherapy, common treatments for lateral epicondylalgia, are frequently combined in clinical practice. However, evidence on their combined efficacy is lacking. To investigate the effectiveness of corticosteroid injection, multimodal physiotherapy, or both in patients with unilateral lateral epicondylalgia. A 2 × 2 factorial, randomized, injection-blinded, placebo-controlled trial was conducted at a single university research center and 16 primary care settings in Brisbane, Australia. A total of 165 patients aged 18 years or older with unilateral lateral epicondylalgia of longer than 6 weeks' duration were enrolled between July 2008 and May 2010 1-year follow-up was completed in May 2011. Corticosteroid injection (n = 43), placebo injection (n = 41), corticosteroid injection plus physiotherapy (n = 40), or placebo injection plus physiotherapy (n = 41). The 2 primary outcomes were 1-year global rating of change scores for complete recovery or much improvement and 1-year recurrence (defined as complete recovery or much improvement at 4 or 8 weeks, but not later) analyzed on an intention-to-treat basis (P < .01). Secondary outcomes included complete recovery or much improvement at 4 and 26 weeks. Corticosteroid injection resulted in lower complete recovery or much improvement at 1 year vs placebo injection (83% vs 96%, respectively relative risk [RR], 0.86 [99% CI, 0.75-0.99] P = .01) and greater 1-year recurrence (54% vs 12% RR, 0.23 [99% CI, 0.10-0.51] P < .001). The physiotherapy and no physiotherapy groups did not differ on 1-year ratings of complete recovery or much improvement (91% vs 88%, respectively RR, 1.04 [99% CI, 0.90-1.19] P = .56) or recurrence (29% vs 38% RR, 1.31 [99% CI, 0.73-2.35] P = .25). Similar patterns were found at 26 weeks, with lower complete recovery or much improvement after corticosteroid injection vs placebo injection (55% vs 85%, respectively RR, 0.79 [99% CI, 0.62-0.99] P < .001) and no difference between the physiotherapy and no physiotherapy groups (71% vs 69%, respectively RR, 1.22 [99% CI, 0.97-1.53] P = .84). At 4 weeks, there was a significant interaction between corticosteroid injection and physiotherapy (P = .01), whereby patients receiving the placebo injection plus physiotherapy had greater complete recovery or much improvement vs no physiotherapy (39% vs 10%, respectively RR, 4.00 [99% CI, 1.07-15.00] P = .004). However, there was no difference between patients receiving the corticosteroid injection plus physiotherapy vs corticosteroid alone (68% vs 71%, respectively RR, 0.95 [99% CI, 0.65-1.38] P = .57). Among patients with chronic unilateral lateral epicondylalgia, the use of corticosteroid injection vs placebo injection resulted in worse clinical outcomes after 1 year, and physiotherapy did not result in any significant differences. anzctr.org Identifier: ACTRN12609000051246.
Publisher: Elsevier BV
Date: 10-2006
Publisher: Oxford University Press (OUP)
Date: 27-08-2007
DOI: 10.1093/RHEUMATOLOGY/KEM192
Abstract: To determine if subgroups of patients with tennis elbow respond differently in treatment. This study used in idual patient data (n = 383) from two randomized controlled trials that investigated a wait-and-see policy, corticosteroid injections and physiotherapy. Common outcome measures were: pain severity, global improvement, severity assessed by a blinded assessor, elbow disability and pain free grip strength. Subgroup analyses for previous history of elbow pain, baseline pain severity, duration of the current episode and employment status were performed at 6 and 52 weeks. Patients' age, previous elbow symptoms and baseline pain severity were similar between trials, but other characteristics differed between trial populations. Based on in idual patient data from both trials, we found that corticosteroid injections were statistically and clinically superior at 6 weeks, but significantly worse at 52 weeks compared with both wait-and-see and physiotherapy. Subgroup effects were scarce and small. Patients with higher baseline pain score showed less benefit on pain outcomes between physiotherapy and a wait-and-see policy at 6 weeks. It also appeared that non-manual workers who had an injection were the only work subgroup to follow the general trend that injections were significantly worse than a wait-and-see policy on global improvement at 52 weeks. The treatment outcomes were largely similar between trials and not different between most subgroups studied. In tennis elbow, it would appear that patient characteristics play only a small role in predicting treatment outcomes, which supports the generalizability of in idual trial results.
Publisher: SAGE Publications
Date: 03-1977
Publisher: Elsevier BV
Date: 2023
DOI: 10.2139/SSRN.4409329
Publisher: Wiley
Date: 02-1999
DOI: 10.1111/J.1445-5994.1999.TB01587.X
Abstract: Systemic sclerosis prevalence and mortality estimates have demonstrated wide variability. The sole Australian study published to date demonstrated high prevalence rates when compared to overseas estimates. The prevalence and mortality findings reported in this paper derive from a larger study which addressed the distribution and determinants of systemic sclerosis within Sydney. To determine systemic sclerosis prevalence and mortality rates within Sydney over 15 years, 1974-88. Cases were ascertained from multiple sources including death certificates, hospitals, physicians, vascular surgeons' and dermatologists' private practices, a systemic sclerosis self-help group and private medical laboratories. Overall, 715 cases were identified. Females comprised 77% (95% CI: 74-80) of cases. Disease of the limited subtype accounted for 79% (95% CI: 76-82) of all systemic sclerosis, being relatively more frequent in living than deceased cases, and in females than males. Crude prevalence estimates appeared to rise between 1975 (4.52/100,000 95% CI:3.75-5.29/100,000) and 1988 (8.62/100,000 95% CI:7.64-9.60/100,000) as did estimates of diffuse disease. However, diffuse disease prevalence, when expressed as a proportion of total disease prevalence, showed no significant temporal change. Although crude mortality rates also showed apparent temporal increases (0.24/100,000 in 1975 to 0.80/100,000 in 1988) standardised mortality rates showed less convincing trends (0.41/100,000 in 1976 and 0.40/100,000 in 1988). Death certificate-derived mortality rates provided relatively large underestimates of total mortality. However, these underestimates were relatively constant over time. This study has demonstrated systemic sclerosis prevalence and mortality rates comparable to overseas estimates, consistently higher prevalence and mortality rates in females than males, proportionally higher rates of diffuse disease in males than females and in deceased cases than living cases, a diffuse: limited disease ratio apparently stable over time, apparently increasing temporal prevalence and mortality rates and, by implication, rising incidence rates. The observed temporal rise in diffuse disease prevalence and the absence of a convincing fall in diffuse disease mortality suggests a rising temporal incidence rate of diffuse disease. Standardised mortality rates demonstrated less consistent trends than did crude mortality rates and failed to demonstrate convincing declines in mortality subsequent to the introduction of ACE inhibitors for management of systemic sclerosis renal disease. Death certificate-derived systemic sclerosis mortality rates considerably and consistently underestimated systemic sclerosis-all cause mortality.
Publisher: AMPCo
Date: 09-2003
DOI: 10.5694/J.1326-5377.2003.TB05534.X
Abstract: Healthcare workforce shortfalls require a rethinking of models for delivering care to people with chronic disease. Chronic disease needs to be managed by a multiskilled team of healthcare professionals with specialist input. Education at undergraduate, graduate and postgraduate levels needs to prepare healthcare professionals for this new paradigm. Some tasks currently seen only as part of a doctor's purview could be performed by other trained professionals to allow doctors to concentrate on more appropriate activities. We need to explore new collaborations to deliver multidisciplinary healthcare for chronic disease and evaluate these for patient outcomes and cost effectiveness.
Publisher: Elsevier BV
Date: 06-1991
DOI: 10.1016/0022-1759(91)90194-K
Abstract: A Nycodenz gradient technique is described which permits the separation of functionally active polymorphonuclear neutrophils (PMN) from the peripheral blood of rats. PMN are obtained at greater than 90% purity and fractionate at a peak density of 1.0919 g/ml. The method is suitable for isolating PMN when the circulating PMN count is low (less than 20%) as in normal rats and when the count is high (greater than 30%), as a result of inducing inflammation in the subcutaneous air pouch of rats by the intra-pouch injection of peptone. The chemotactic responsiveness of rat PMN was found to be markedly less than that of human PMN when the formyl peptides were used as chemoattractants but not when zymosan-activated serum was the chemoattractant. Blood PMN from normal rats and from peptone-treated rats showed no significant difference in their response to ZAS indicating that priming of their activity by the induction of long term (8 day) inflammation was not a feature of these experiments. However, air pouch-derived PMN displayed a highly significant reduction in activity compared with their isologous blood-PMN. The Nycodenz method offers an alternative to the Percoll separation method for rat blood and will be useful when comparative studies of elicited and non-elicited PMN are required since the latter are obtained in sufficiently high yield and purity for microassays on their function to be performed.
Publisher: The Journal of Rheumatology
Date: 02-2019
Abstract: The Outcome Measures in Rheumatology (OMERACT) Shared Decision Making (SDM) Working Group aims to determine the core outcome domain set for measuring the effectiveness of SDM interventions in rheumatology trials. A white paper was developed to clarify the draft core domain set. It was then used to prepare for interviews to investigate reasons for lack of consensus on it and to suggest further improvements. OMERACT scientists/clinicians (n = 13) and patients (n = 10) suggested limiting the core domain set to outcome domains, removing process domains, and clarifying remaining domains. A revised core domain set will undergo further consensus-building.
Publisher: Wiley
Date: 1983
DOI: 10.1111/J.1365-2125.1983.TB01469.X
Abstract: 1 The protein binding of seven non-steroidal anti-inflammatory drugs (indomethacin, tolmetin, salicylic acid, ibuprofen, flurbiprofen, naproxen and GP53,633) and warfarin was investigated by equilibrium dialysis in simultaneous s les of synovial fluid and plasma from 12 arthritic patients. 2 The protein binding of all drugs studied except warfarin and flurbiprofen was significantly lower in synovial fluid than in plasma. 3 The decreased protein binding of these drugs is likely to explain the lower total drug concentrations found in synovial fluid in comparison to plasma. 4 The lower albumin concentration plays an important role in determination of reduced drug binding in synovial fluid compared to plasma and the fatty acid concentration in synovial fluid may also influence the protein binding of some of these drugs.
Publisher: Oxford University Press (OUP)
Date: 1994
DOI: 10.1093/RHEUMATOLOGY/33.10.947
Abstract: The aim of our study was to compare the safety and efficacy of a new preparation, Dysprosium-165 Hydroxide Macroaggregate (165Dy) with Yttrium-90 Silicate (90Y) for radiation synovectomy of the knee in patients with RA and OA. A multicentre double blind clinical trial with subjects randomized to receive 165Dy or 90Y was undertaken in Sydney, Melbourne and Perth. Seventy knees of 59 patients were studied, using as clinical end point measurements, pain in the knee on walking, pain in the knee at rest and stiffness in the knee after rest. Cytogenetic damage, knee retention and extra-articular spread of the radionuclide to regional lymph nodes, liver, urine and blood were evaluated. There was no significant difference in clinical response in the two treatment groups for either RA or OA. Chromosomal changes occurred with equal frequency and the knee retention and extra-articular leakage of radiocolloids to regional lymph nodes and liver were comparable in the two groups. For radiation synovectomy of the knee, 165Dy is at least as safe and as effective as 90Y and has the advantage of a short half-life (2.334 h) and hence requires a shorter period of post-injection immobilization and hospitalization.
Publisher: SAGE Publications
Date: 22-10-2018
Abstract: Information and communications technology has become central to the way in which health services are provided. Technology-enabled services in healthcare are often described as eHealth, or more recently, digital health. Practitioners may require new knowledge, skills and competencies to make best use of eHealth, and while universities may be a logical place to provide such education and training, a study in 2012 found that the workforce was not being adequately educated to achieve competence to work with eHealth. We revisited eHealth education and training in Australian universities with a focus on medical schools we aimed to explore the progress of eHealth in the Australian medical curriculum. We conducted a national interview study and interpretative phenomenological analysis with participants from all 19 medical schools in Australia two themes emerged: (i) consensus on the importance of eHealth to current and future clinical practice (ii) there are other priorities, and no strong drivers for change. Systemic problems inhibit the inclusion of eHealth in medical education: the curriculum is described as ‘crowded’ and with competing demands, and because accrediting bodies do not expect eHealth competence in medical graduates, there is no external pressure for its inclusion. Unless and until accrediting bodies recognise and expect competence in eHealth, it is unlikely that it will enter the curriculum consequently the future workforce will remain unprepared.
Publisher: Wiley
Date: 09-1988
Abstract: A procedure for the quantification of leukotriene B4 (LTB4) in synovial fluid has been developed using gas chromatography/tandem mass spectrometry based on selected reaction monitoring of the elimination of t-butyldimethylsilanol from the ions of m/z 431 and 438 in the negative ion chemical ionization mass spectra of the di-t-butyldimethylsilyl entafluorobenzyl derivatives of leukotriene B4 and the internal standard (2H8)leukotriene B4. The detection limit (approximately 10 pg ml-1) is sufficiently low to permit determination of LTB4 concentration in the synovial fluid of patients with various arthropathies. Single-stage mass spectrometry was found not to be selective enough to permit quantification of LTB4 in synovial fluid.
Publisher: Wiley
Date: 25-05-2012
DOI: 10.1002/ART.34347
Abstract: To perform a systematic review of the global prevalence of low back pain, and to examine the influence that case definition, prevalence period, and other variables have on prevalence. We conducted a new systematic review of the global prevalence of low back pain that included general population studies published between 1980 and 2009. A total of 165 studies from 54 countries were identified. Of these, 64% had been published since the last comparable review. Low back pain was shown to be a major problem throughout the world, with the highest prevalence among female in iduals and those aged 40-80 years. After adjusting for methodologic variation, the mean ± SEM point prevalence was estimated to be 11.9 ± 2.0%, and the 1-month prevalence was estimated to be 23.2 ± 2.9%. As the population ages, the global number of in iduals with low back pain is likely to increase substantially over the coming decades. Investigators are encouraged to adopt recent recommendations for a standard definition of low back pain and to consult a recently developed tool for assessing the risk of bias of prevalence studies.
Publisher: Oxford University Press (OUP)
Date: 06-1990
DOI: 10.1111/J.1365-2249.1990.TB03306.X
Abstract: IL-1 production (secreted and cell-associated) was measured in monocyte cultures stimulated by a variety of agents in vitro. Monocytes either adherent to conventional plastic culture plates in serum-free conditions, or in suspension in culture medium containing serum were stimulated to produce IL-1 during culture. In non-adherent, serum-free conditions, monocytes produced very low or undetectable amounts of IL-1 during 20 h of culture. Lipopolysaccharide (LPS) induced equivalent amounts of secreted and cell-associated IL-1, although at very low concentrations more cell-associated IL-1 was produced. IL-1 production in response to LPS could be augmented by crude lymphokine, IFN-γ, or tumour necrosis factor (TNF) alpha. TNF-α preferentially augmented the production of cell-associated IL-1 in LPS-stimulated cultures. TNF-α induced a significant amount of IL-1 (mainly cell-associated) directly but could also induce IL-1 secretion when combined with IL-2 or IFN-γ, or when in the presence of serum. IL-2 acted synergislically with low concentrations of IFN-γ or IL-1 to induce significant levels of IL-1 production. IFN-α did not induce any IL-1 production, but was a potent inhibitor of IL-1 production induced by a variety of stimuli. These results suggest that IL-1 production may be enhanced or reduced by different cytokines at concentrations likely to be found in chronic inflammatory lesions.
Publisher: Elsevier BV
Date: 04-1990
DOI: 10.1016/0090-6980(90)90121-B
Abstract: The effect of methanol on the ability of elicited rat peritoneal leukocytes to metabolise endogenous and exogenous arachidonic acid was studied using 2H8-arachidonic acid as the source of exogenous arachidonic acid and calcium ionophore A23187 as the lipoxygenase stimulus. As the methanol concentration increased from 0 to 992 mM there was a slight decrease in the total amount of LTB4 and related compounds formed, however examination of the ratio of undeuterated to deuterated LTB4 formed revealed that as the methanol concentration increased from 0 to 992 mM, the percentage of undeuterated LTB4 present decreased significantly from 57 +/- 9% to 2 +/- 1%. Methanol interferes with the ability of these cells to utilise endogenous arachidonic acid even in the presence of the powerful stimulus calcium ionophore A23187 thus allowing the facile biosynthesis of a range of deuterium labelled arachidonic acid metabolites.
Publisher: Wiley
Date: 12-1983
DOI: 10.1111/J.1445-5994.1983.TB02608.X
Abstract: Plasma concentrations of methylprednisolone following intra-articular injection were measured in rheumatoid arthritis and osteoarthritis patients. While substantial plasma concentrations were seen in both groups of patients there was no significant difference in the rate or extent of absorption of methylprednisolone from osteoarthritic or rheumatoid knees. This study suggests that it is the dissolution rate of the steroid formulation rather than the characteristics of the synovial membrane which determine rate and extent of systemic absorption of methylprednisolone after intra-articular injection.
Publisher: Wiley
Date: 12-1983
DOI: 10.1111/J.1445-5994.1983.TB02623.X
Abstract: An 83 year old female presenting with a symmetrical peripheral polyarthritis resembling rheumatoid arthritis, subsequently developed biopsy-proven temporal arteritis. This case report draws attention to this uncommon presentation of temporal arteritis and briefly reviews common presenting features of this condition.
Publisher: Springer Science and Business Media LLC
Date: 12-1998
Abstract: Autologous haemopoietic stem cell transplantation (HSCT) represents a potential therapy for severe rheumatoid arthritis (RA). As a prelude to clinical trails, the safety and efficacy of haemopoietic stem cell (HSC) mobilisation required investigation as colony-stimulating factors (CSFs) have been reported to flare RA. A double-blind, randomised placebo-controlled dose escalation study was performed. Two cohorts of eight patients fulfilling strict eligibility criteria for severe active RA (age median 40 years, range 24-60 years median disease duration 10.5 years, range 2-18 years) received filgrastim (r-Hu-methionyl granulocyte(G)-CSF) at 5 and 10 microg/kg/day, randomised in a 5:3 ratio with placebo. Patients were unblinded on the fifth day of treatment and those randomised to filgrastim underwent cell harvesting (leukapheresis) daily until 2 x 10(6)/kg CD34+ cells (haemopoietic stem and progenitor cells) were obtained. Patients were assessed by clinical and laboratory parameters before, during and after filgrastim administration. RA flare was defined as an increase of 30% or more in two of the following parameters: tender joint count, swollen joint count or pain score. Efficacy was assessed by quantitation of CD34+ cells and CFU-GM. One patient in the 5 microg/kg/day group and two patients in the 10 microg/kg/day group fulfilled criteria for RA flare, although this did not preclude successful stem cell collection. Median changes in swollen and tender joint counts were not supportive of filgrastim consistently causing exacerbation of disease, but administration of filgrastim at 10 microg/kg/day was associated with rises in median C-reactive protein and median rheumatoid factor compared with placebo. Other adverse events were well recognised for filgrastim and included bone pain (80%) and increases in alkaline phosphatase (four-fold) and lactate dehydrogenase (two-fold). With respect to efficacy, filgrastim at 10 microg/kg/day was more efficient with all patients (n = 5) achieving target CD34+ cell counts with a single leukapheresis (median = 2.8, range = 2.3-4.8 x 10(6)/kg, median CFU-GM = 22.1, range = 4.2-102.9 x 10(4)/kg), whereas 1-3 leukaphereses were necessary to achieve the target yield using 5 microg/kg/day. We conclude that filgrastim may be administered to patients with severe active RA for effective stem cell mobilisation. Flare of RA occurs in a minority of patients and is more likely with 10 than 5 microg/kg/day. However, on balance, 10 microg/kg/day remains the dose of choice in view of more efficient CD34+ cell mobilisation.
Publisher: Informa Healthcare
Date: 1977
DOI: 10.1185/03007997709108977
Abstract: Fifteen patients with seropositive rheumatoid arthritis were treated for 2-weeks periods with 150 mg flurbiprofen daily and with flubriprofen in the same dosage plus 3 g aspirin daily, the treatments being administered in random allocation. The results showed that there were no significant differences clinically between the two treatments. Serum levels of flurbiprofen were measured during both treatment periods in 4 patients. During the flurbiprofen and aspirin period there was a full in the serum levels of flurbiprofen was unchanged. No obvious reduction in clinical efficacy was apparent.
Publisher: AMPCo
Date: 03-2004
Publisher: Informa Healthcare
Date: 1982
DOI: 10.1185/03007998209112383
Abstract: Indomethacin is commonly prescribed at night to relieve morning stiffness in patients with rheumatoid arthritis. Pharmacokinetic and pharmacodynamic interactions are frequently described with non-steroidal anti-inflammatory drugs, and the rationale of using more than one of these agents at the same time is questionable. A randomized crossover trial was carried out in 14 patients to compare the effects of 100 mg indomethacin at night with those of placebo when added to a baseline regimen of stabilized salicylate therapy with a slow-release preparation. Each treatment was given for 2 weeks. The results suggest that the addition of indomethacin produced no significant benefit in terms of reduction in the duration of morning stiffness or on the overall daily pain score.
Publisher: Oxford University Press (OUP)
Date: 1982
DOI: 10.1093/RHEUMATOLOGY/21.4.242
Abstract: A six-week double-blind randomized cross-over trial comparing the safety and efficacy of 250 mg naproxen administered twice daily and 500 mg naproxen administered as a single dose at night in osteoarthritic patients stabilized on naproxen 250 mg twice daily is reported. There was no significant difference between the two regimens. This study provides evidence that naproxen can be given to patients with osteoarthritis on a single-daily-dose regimen without any loss of anti-inflammatory/analgesic activity.
Publisher: Informa UK Limited
Date: 24-07-2013
DOI: 10.3109/13561820.2013.816272
Abstract: The majority of interprofessional learning literature focuses on initiatives within pre-clinical or simulated learning environments, with a paucity of research exploring the variation in impact of exposure to nurses and other health professionals in different health care settings. This study aimed to explore the experiences and attitudes of medical students following scheduled placements in palliative and rehabilitative care units. Three focus groups were conducted by researchers independent of the clinical school, to explore the attitudes of first clinical year medical students towards, and experiences of, a clinical placement that provided the opportunity to develop interprofessional skills. Students responded differently to the expectation put upon them to initiate their own learning experiences. A number of students felt that being asked to focus on clinical skill development conflicted with the assessment demands of the medical curriculum. This, in turn, contributed to a missed opportunity for them to learn with, from and about nurses and other health professionals. The driver of assessment was seen to be more important to their training. This emphasises the importance of including an assessment of interprofessional skills if we want to ensure students achieve these skills. If medical students are not going to be assessed on interprofessional knowledge, skills and attitudes then a curriculum orientation to the value of interprofessional practice is required.
Publisher: Oxford University Press (OUP)
Date: 1990
DOI: 10.1093/RHEUMATOLOGY/29.2.120
Abstract: Fifty-three patients with rheumatoid arthritis who required immunosuppressive therapy were commenced in a randomized trial comparing azathioprine to weekly oral pulse methotrexate. After an initial 24-week period, both groups had significantly improved from baseline measures of pain and functional capacity and there were no significant differences in clinical outcomes between the two groups. Laboratory variables of disease activity showed a significant improvement in haemoglobin and ESR in the methotrexate group. Subsequently, the patients were followed for up to 3 years. After one year, more than half of the patients in both groups had discontinued therapy due to inefficacy or adverse events. Adverse effects were more frequent in the patients treated with methotrexate, but withdrawal rates were similar in both groups. From these data, the probability of a patient continuing therapy with either agent for greater than 18 months is low.
Publisher: Wiley
Date: 12-1988
DOI: 10.1111/J.1365-2125.1988.TB05316.X
Abstract: 1. A clinical trial was conducted with flurbiprofen 100 mg three times a day by mouth in rheumatoid arthritis to determine variability in response. 2. Forty patients entered the study, but only 32 completed it. Patients were treated with flurbiprofen on two occasions at a month's interval, each being preceded by a 3 day wash out period. Pain relief and a Ritchie articular index of joint tenderness was assessed at the beginning and end of each treatment period. 3. Flurbiprofen produced significant improvement in both pain relief and articular tenderness. No significant differences were observed between the two trial periods in the mean of these outcome measures. 4. No evidence was found to support the concept of responders and non-responders.
Publisher: AMPCo
Date: 06-2015
DOI: 10.5694/MJA15.00170
Publisher: Springer Science and Business Media LLC
Date: 07-1997
Abstract: We report a patient who underwent allogeneic bone marrow transplantation from a sibling with longstanding untreated severe active rheumatoid arthritis. After 4 years of follow-up there is no evidence of adoptive transfer of rheumatoid arthritis to the recipient. This case, along with another recently reported case, provides reassurance that haemopoietic stem cell transplantation from a donor with systemic autoimmune disease may not necessarily result in adoptive transfer of the disease. All previous reports of transfer of autoimmunity in humans have been of organ-specific autoimmune diseases and we speculate that pathophysiological differences might account for why systemic autoimmune disease is not transferred.
Publisher: Wiley
Date: 04-1994
Publisher: Wiley
Date: 04-1986
DOI: 10.1111/J.1365-2125.1986.TB02993.X
Abstract: 1 Anti-inflammatory effects of isoxicam alone and in combination with aspirin were studied in rats using the polyurethane sponge implantation model of acute inflammation. 2 Dose-response studies were performed to delineate a suppressive (high) and non-suppressive (low) dose of isoxicam prior to studying these doses in combination with aspirin. 3 The results indicate that a combination of aspirin with isoxicam does not have an additive anti-inflammatory effect. 4 The interference demonstrated by aspirin with the anti-inflammatory effects of other NSAIDs such as indomethacin is also demonstrated with aspirin/isoxicam combinations.
Publisher: Wiley
Date: 02-1982
DOI: 10.1111/J.1445-5994.1982.TB02416.X
Abstract: Aortic root abnormalities including cusp thickening, subvalvular stenosis, and mild aortic root dilatation are the most common cardiac complications in patients with long standing ankylosing spondylitis (AS). Twenty-three patients with definite idiopathic AS (New York Criteria 1966) and twenty-two matched controls were studied with M-mode echocardiography. Only one of the AS patients had clinical aortic incompetence. Six of the AS patients had mildly dilated aortic roots (normal less than 3.7 cm) with a mean diameter of 3.9 cm (range 3.8 to 4.00 cm). None of the twenty-two controls matched for age, sex and blood pressure had dilated aortic roots, with a mean diameter of 3.3 cm (range 2.9 to 3.6 cm). No correlation existed between aortic dilatation and severity of disease estimated by acute phase proteins--caerulo plasmin, alpha 1-antitrypsin, alpha 1 acid glycoprotein, ferritin and C Reactive protein. Contrary to a previous report, mild aortic root dilatation occurs in long standing cases of AS. Although it is a non-specific finding, it does not appear to be related to age or blood pressure and may therefore be the forerunner of aortic incompetence.
Publisher: AMPCo
Date: 11-1985
DOI: 10.5694/J.1326-5377.1985.TB119909.X
Abstract: In 1981, questionnaires seeking information about the teaching of medicine in general, and rheumatology in particular, were sent to random s les of undergraduates in Australian medical schools and trainees in the Family Medicine Programme (FMP) of the Royal Australian College of General Practitioners. Neurology rated most highly, with the majority of undergraduates considering it to be well taught and interesting by contrast, rheumatology was perceived as being badly taught and lacking in interest. Many graduates had never attended rheumatology outpatient clinics either as undergraduates (45%) or as FMP trainees (68%). Only 40% of the graduates had ever been attached to a rheumatology inpatient service, and fewer than 50% had received any teaching about the role of physiotherapists or occupational therapists in the management of patients with arthritis.
Publisher: BMJ
Date: 06-1984
DOI: 10.1136/ARD.43.3.402
Abstract: The mechanism of D-penicillamine induced thrombocytopenia in rheumatoid arthritis was investigated by measuring platelet life-span and platelet production rate in 2 groups of rheumatoid arthritis patients treated with 250-750 mg/day D-penicillamine, 14 with a normal platelet count and 9 with thrombocytopenia (platelet count 50-130 X 10(9)/1). Age matched control patients not treated with D-penicillamine included 14 with rheumatoid arthritis and 9 with osteoarthritis. The platelet life-span was normal, but platelet production rate was significantly reduced in the thrombocytopenic patients, suggesting that D-penicillamine causes thrombocytopenia through bone marrow suppression.
Publisher: Elsevier BV
Date: 09-2006
DOI: 10.1016/J.JOCA.2006.02.012
Abstract: Five double-blind, randomized, saline-controlled trials (RCTs) were included in the United States marketing application for an intra-articular hyaluronan (IA-HA) product for the treatment of osteoarthritis (OA) of the knee. We report an integrated analysis of the primary Case Report Form (CRF) data from these trials. Trials were similar in design, patient population and outcome measures - all included the Lequèsne Algofunctional Index (LI), a validated composite index of pain and function, evaluating treatment over 3 months. In idual patient data were pooled a repeated measures analysis of covariance was performed in the intent-to-treat (ITT) population. Analyses utilized both fixed and random effects models. Safety data from the five RCTs were summarized. A total of 1155 patients with radiologically confirmed knee OA were enrolled: 619 received three or five IA-HA injections 536 received "placebo" saline injections. In the active and control groups, mean ages were 61.8 and 61.4 years 62.4% and 58.8% were women baseline total Lequèsne scores 11.03 and 11.30, respectively. Integrated analysis of the pooled data set found a statistically significant reduction (P < 0.001) in total Lequèsne score with hyaluronan (HA) (-2.68) vs placebo (-2.00) estimated difference -0.68 (95% CI: -0.56 to -0.79), effect size 0.20. Additional modeling approaches confirmed robustness of the analyses. This integrated analysis demonstrates that multiple design factors influence the results of RCTs assessing efficacy of intra-articular (IA) therapies, and that integrated analyses based on primary data differ from meta-analyses using transformed data.
Publisher: Elsevier BV
Date: 12-1996
DOI: 10.1111/J.1467-842X.1996.TB01068.X
Abstract: The main objective of this study was to see if older people could maintain their quality of life and independence after their homes had been modified and they were using community services as recommended by an occupational therapist. There were 167 study participants aged 69 to 94 years from the Northern Sydney Area. After being assessed at home by an occupational therapist, 105 were randomly allocated to one of two groups, to either have or not have the occupational therapist's recommendations carried out. They were assessed again after six months. A third group did not require any intervention. This group was followed up by telephone and postal questionnaire at six months. The main outcome measures used were the Sickness Impact Profile, the Philadelphia Geriatric Center Morale Scale, the Life Satisfaction Index, assessment of Activities of Daily Living, the Health Assessment Questionnaire and change in residence. After six months there were no difference in outcomes among the three groups. Most study participants remained at a satisfactory level on each measure. Three people had died. One had moved to hostel care and one had moved to a nursing home. A further 14 from the group having no intervention had withdrawn from the study. A secondary objective of this study was to indicate the responsiveness of these outcome measures to change in the short term (over six months) in an elderly population. Twelve-month assessments are in progress and may indicate what to expect from these outcome measures in the medium term.
Publisher: Wiley
Date: 02-1994
DOI: 10.1111/J.1445-5994.1994.TB04439.X
Abstract: The studies implicating a causal relationship between silicone and scleroderma, other autoimmune disease, and fibromyalgia-like symptoms have been largely descriptive with absence of appropriate controls and no consideration of potential confounders. This case control study of augmentation mammoplasty and scleroderma represents an attempt to answer these deficiencies. To compare the frequency and temporal relationship of augmentation mammoplasty in interviewed and deceased cases and interviewed controls. To determine the frequencies of exposure to non-augmentation mammoplasty silicone, and to determine the frequencies of mastectomy and breast lumpectomy in interviewed cases and controls. Scleroderma cases and age-stratified general practice controls were interviewed using a prepilotted telephone questionnaire. Self-reported date/s of augmentation mammoplasty were ascertained, as were dates of onset of first and second scleroderma symptom/s and scleroderma diagnosis, where relevant. Comparison of socioeconomically adjusted rates was expressed in terms of rate ratios. Augmentation mammoplasty rates were comparable between interviewed cases and controls. No augmentation mammoplasty procedures were documented in deceased scleroderma patients' medical records. Rates of exposure to non-mammoplasty silicone, mastectomy and breast lumpectomy were comparable in interviewed cases and controls. This study failed to demonstrate an association between silicone breast implantation and the subsequent development of scleroderma, to a relative risk level as low as 4.5 with 90% power.
Publisher: CSIRO Publishing
Date: 18-12-2020
DOI: 10.1071/AH20126
Abstract: Objective This study determined the economic impact of 16 ‘high-priority’ hospital-acquired complications (HACs), as defined by the Australian Commission on Safety and Quality in Health Care, from the perspective of an in idual Australian health service. Methods A retrospective cohort study was performed using a deidentified patient dataset containing 93 056 in-patient separations in Northern Health (Victoria, Australia) from 1 July 2016 to 30 June 2017. Two log-linked generalised linear regression models were used to obtain additional costs and additional length of stay (LOS) for 16 different HACs, with the main outcome measures being the additional cost and LOS for all 16 HACs. Results In all, 1700 separations involving HACs (1.83%) were identified. The most common HAC was health care-associated infections. Most HACs were associated with a statistically significant risk of increased cost (15/16 HACs) and LOS (11/16 HACs). HACs involving falls resulting in fracture or other intracranial injury were associated with the highest additional cost (A$17 173). The biggest increase in additional LOS was unplanned admissions to the intensive care unit (5.42 days). Conclusions This study shows the economic impact of HACs from the perspective of an in idual health service. The methodology used demonstrates how other health services could determine safety priorities corresponding to their own casemix. What is known about the topic? HACs are a major issue in Australian health care however, their effect on cost and LOS at the in idual health service level is not well quantified. What does this paper add? Additional cost and LOS implications for 16 high-priority HACs have been quantified within an Australian health service. There is substantial variation in terms of the number of HACs and the economic impact of each HAC. What are the implications for practitioners? This study provides a template for other health services to assess the economic impact of HACs corresponding to their own casemix and to inform targeted patient safety programs.
Publisher: Springer Science and Business Media LLC
Date: 22-01-2016
Publisher: Springer Science and Business Media LLC
Date: 12-1987
DOI: 10.1007/BF02330589
Abstract: A 44 year old man presented with classical pattern of bipolar disorder with a fortnightly cycle of mania and depression for last many years. The patient was not responding to chronic lithium therapy but responded to a combination of carbamazepine and nifedipine.
Publisher: BMJ
Date: 30-01-2014
DOI: 10.1136/ANNRHEUMDIS-2013-204431
Abstract: To estimate the global burden of neck pain. Neck pain was defined as pain in the neck with or without pain referred into one or both upper limbs that lasts for at least 1 day. Systematic reviews were performed of the prevalence, incidence, remission, duration and mortality risk of neck pain. Four levels of severity were identified for neck pain with and without arm pain, each with their own disability weights. A Bayesian meta-regression method was used to pool prevalence and derive missing age/sex/region/year values. The disability weights were applied to prevalence values to derive the overall disability of neck pain expressed as years lived with disability (YLDs). YLDs have the same value as disability-adjusted life years as there is no evidence of mortality associated with neck pain. The global point prevalence of neck pain was 4.9% (95% CI 4.6 to 5.3). Disability-adjusted life years increased from 23.9 million (95% CI 16.5 to 33.1) in 1990 to 33.6 million (95% CI 23.5 to 46.5) in 2010. Out of all 291 conditions studied in the Global Burden of Disease 2010 Study, neck pain ranked 4th highest in terms of disability as measured by YLDs, and 21st in terms of overall burden. Neck pain is a common condition that causes substantial disability. With aging global populations, further research is urgently needed to better understand the predictors and clinical course of neck pain, as well as the ways in which neck pain can be prevented and better managed.
Publisher: Wiley
Date: 06-1987
DOI: 10.1111/J.1445-5994.1987.TB01238.X
Abstract: We report a case of oncogenic hypophosphatemic osteomalacia, a rare form of osteomalacia, secondary to a diffuse giant cell tumour of tendon sheath. Possible pathogenic factors are discussed in the light of previously described clinical and experimental observations.
Publisher: Oxford University Press (OUP)
Date: 1995
DOI: 10.1093/RHEUMATOLOGY/34.7.647
Abstract: A 5-yr follow-up of an arthritis education programme is reported. After adjustment for those lost, deceased or moved away, the 5-yr response rate was 75% among intervention subjects and 78% among controls. In iduals who participated in the education programme maintained their increased knowledge in some aspects. The relative difference in pain and disability over 5 yr was greater in the control group. Most in iduals were less active at practising exercise after 5 yr. Improvement in performing exercise and joint protection shown at 12-months follow-up did not persist. Additional questions after 5 yr showed that participants in the education programme had significantly more contact with rheumatologists, physiotherapists and occupational therapists. The participants developed an increased internal sense of control of the disease between 12 months and 5 yr. There was also a significant reduction in reported problems with their disease after 12 months, maintained after 5 yr. This may indicate that patient education contributes to the patient's feeling of responsibility for, and ability to cope with, their diseases.
Publisher: Informa UK Limited
Date: 1991
DOI: 10.3109/10641969109042120
Abstract: A placebo-controlled, double blind crossover study of the non-steroidal anti-inflammatory drugs (NSAIDs) sulindac and diclofenac was conducted in 16 patients with essential hypertension that was controlled by treatment with a beta blocker, a diuretic or co-administration of both. In 4 cases, another antihypertensive agent (prazosin or verapamil) was also co-administered. In every patient, plasma creatinine concentration was less than 0.14 mmol/l (normal range 0.07-0.12 mmol/l). Sulindac and diclofenac were each given for 7 weeks. Diclofenac caused a decrease of borderline significance in plasma aldosterone concentration. Neither NSAID altered the mean values for systolic or diastolic blood pressure, body weight, plasma electrolyte concentrations, urate clearance, creatinine clearance or plasma renin activity. However, rises in plasma creatinine concentration and falls in creatinine clearance occurred during NSAID therapy in three in idual subjects. No significant differences were observed in this study between the effects on renal function or blood pressure of sulindac and diclofenac, both of which appear not to interfere with the antihypertensive actions of beta blockers and diuretics.
Publisher: Elsevier BV
Date: 1987
DOI: 10.1016/0022-3999(87)90024-9
Abstract: A three year prospective study of 30 patients with established rheumatoid arthritis demonstrated that symptoms of depression and anxiety predicted a good outcome whilst externalized hostility predicted a poorer outcome. A multiple regression analysis further showed that patients who denied the emotional significance of their illness faired worse. Psychological variables accounted for 32% of the variance of outcome.
Publisher: Springer Science and Business Media LLC
Date: 09-1988
DOI: 10.1007/BF01965040
Abstract: Slender bundled actin containing plasma membrane protrusions, called filopodia, are important for many essential cellular processes like cell adhesion, migration, angiogenesis and the formation of cell-cell contacts. In migrating cells, filopodia are the pioneers at the leading edge which probe the environment for cues. Integrins are cell surface adhesion receptors critically implicated in cell migration and they are transported actively to filopodia tips by an unconventional myosin, myosin-X. Integrin mediated adhesion stabilizes filopodia and promotes cell migration even though integrins are not essential for filopodia initiation. Myosin-X binds also PIP3 and this regulates its activation and localization to filopodia. Filopodia stimulate cell migration in many cell types and increased filopodia density has been described in cancer. Furthermore, several proteins implicated in filopodia formation, like fascin, are also relevant for cancer progression. To investigate this further, we performed a meta-analysis of the expression profiles of 10 filopodia-linked genes in human breast cancer. These data implicated that several different filopodia inducing genes may contribute in a collective manner to cancer progression and the high metastasis rates associated with basal-type breast carcinomas.
Publisher: AMPCo
Date: 08-1997
DOI: 10.5694/J.1326-5377.1997.TB138811.X
Abstract: To assess the efficacy and safety of a copper-salicylate gel in osteoarthritis of the hip and knee. Randomised, double-blind, placebo-controlled study. Rheumatology Clinic of St Vincent's Hospital, Sydney, New South Wales (a tertiary referral hospital), June 1993 to October 1994. 116 patients with pain associated with osteoarthritis of the hip and/or knee (diagnosed by criteria of the European League against Rheumatism), drawn from patients attending the Clinic or self-referred after newspaper advertisements. Copper-salicylate or placebo gel (1.5 g) applied twice daily to the forearm for four weeks. Self-assessment of pain before the trial and after two and four weeks of treatment patient and investigator assessments of efficacy additional analgesia required adverse reactions and withdrawal rates. Pain scores at rest and on movement decreased in both the copper-salicylate and placebo groups by 13%-20%. There was no significant difference between the two groups for decrease in pain score, patient and investigator efficacy ratings, number of patients requiring paracetamol for extra analgesia (active, 77% placebo, 71%) and average dose of paracetamol (active, 555 mg/day placebo, 600 mg/day). Significantly more patients in the copper-salicylate group reported adverse reactions (83% versus 52% of the placebo group), most commonly skin reactions, and withdrew from the trial because of these reactions (17% versus 1.7% of the placebo group). Copper-salicylate gel applied to the forearm was no better than placebo gel as pain relief for patients with osteoarthritis of the hip or knee, but produced significantly more skin rashes.
Publisher: Oxford University Press (OUP)
Date: 1988
DOI: 10.1093/RHEUMATOLOGY/27.2.138
Abstract: By means of a questionnaire, we have determined the combination of clinical features and laboratory tests which rheumatologists, nephrologists, immunologists, and neurologists in New South Wales consider most helpful in discriminating between central nervous system (CNS) involvement due to systemic lupus erythematosus (SLE) and that due to other causes. There was a uniformity of views amongst the four specialties in terms of the likelihood that a given clinical presentation was due to active CNS lupus. The clinical presentation made little difference to the interpretation of laboratory data. CNS abnormalities (EEG, CT, and CSF), as well as the finding of serum DNA antibody of 95%, influenced decision-making, although the other serological tests had little impact. There was disagreement amongst physicians as to whether a given test abnormality (e.g. focal CT scan abnormality) supported or rejected the diagnosis of active CNS lupus. This study indicates that physicians interpret test results selectively in their assessment of patients with SLE who develop CNS symptoms.
Publisher: The Journal of Rheumatology
Date: 03-0002
Abstract: The Outcome Measures in Rheumatology (OMERACT) Filter provides a framework for the validation of outcome measures for use in rheumatology clinical research. However, imaging and biochemical measures may face additional validation challenges because of their technical nature. The Imaging and Soluble Biomarker Session at OMERACT 11 aimed to provide a guide for the iterative development of an imaging or biochemical measurement instrument so it can be used in therapeutic assessment. A hierarchical structure was proposed, reflecting 3 dimensions needed for validating an imaging or biochemical measurement instrument: outcome domain(s), study setting, and performance of the instrument. Movement along the axes in any dimension reflects increasing validation. For a given test instrument, the 3-axis structure assesses the extent to which the instrument is a validated measure for the chosen domain, whether it assesses a patient-centered or disease-centered variable, and whether its technical performance is adequate in the context of its application. Some currently used imaging and soluble biomarkers for rheumatoid arthritis, spondyloarthritis, and knee osteoarthritis were then evaluated using the original OMERACT Filter and the newly proposed structure. Breakout groups critically reviewed the extent to which the candidate biomarkers complied with the proposed stepwise approach, as a way of examining the utility of the proposed 3-dimensional structure. Although there was a broad acceptance of the value of the proposed structure in general, some areas for improvement were suggested including clarification of criteria for achieving a certain level of validation and how to deal with extension of the structure to areas beyond clinical trials. General support was obtained for a proposed tri-axis structure to assess validation of imaging and soluble biomarkers nevertheless, additional work is required to better evaluate its place within the OMERACT Filter 2.0.
Publisher: The Journal of Rheumatology
Date: 03-2014
Abstract: The Outcome Measures in Rheumatology (OMERACT) initiative works to develop core sets of outcome measures for trials and observational studies in rheumatology. At the OMERACT 11 meeting, substantial time was devoted to discussing a conceptual framework and a proposal for a more explicit working process to develop what we now propose to term core outcome measurement sets, collectively termed “OMERACT Filter 2.0.” Preconference work included a literature review, and discussion of preliminary proposals through face-to-face discussions and Internet-based surveys with people within and outside rheumatology. At the conference, 5 interactive sessions comprising plenary and small-group discussions reflected on the proposals from the viewpoint of previous and ongoing OMERACT work. These considerations were brought together in a final OMERACT presentation seeking consensus agreement for the Filter 2.0 framework. After debate, clarification, and agreed alterations, the final proposal suggested all core sets should contain at least 1 measurement instrument from 3 Core Areas: Death, Life Impact, and Pathophysiological Manifestations, and preferably 1 from the area Resource Use. The process of core set development for a health condition starts by selecting core domains within the areas (“core domain set”). This requires literature searches, involvement (especially of patients), and at least 1 consensus process. Next, developers select at least 1 applicable measurement instrument for each core domain. Applicability refers to the original OMERACT Filter and means that the instrument must be truthful (face, content, and construct validity), discriminative (between situations of interest) and feasible (understandable and with acceptable time and monetary costs). Depending on the quality of the instruments, participants formulate either a preliminary or a final “core outcome measurement set.” At final vote, 96% of participants agreed “The proposed overall framework for Filter 2.0 is a suitable basis on which to elaborate a Filter 2.0 Handbook.” Within OMERACT, Filter 2.0 has made established working processes more explicit and includes a broadly endorsed conceptual framework for core outcome measurement set development.
Publisher: Oxford University Press (OUP)
Date: 1990
DOI: 10.1093/RHEUMATOLOGY/29.6.445
Abstract: In this open pilot study a combination of hydroxychloroquine, prednisolone and alternating months of treatment with sulphasalazine or oral weekly pulse methotrexate has been investigated in 16 patients with rheumatoid arthritis (RA) refractory to a total of 67 disease suppressive medications. Results at 3 months indicated significant improvements in visual analogue score for pain, joint count, Ritchie index, scale of disability related to activities of daily living, ESR, rheumatoid factor and C-reactive protein. This degree of improvement, however, was not maintained 6 and 12 months after commencement of treatment. Pain score, Ritchie index and ESR were the only parameters demonstrating significant improvement at 12 months. Therapy was terminated in eight patients, half due to lack of efficacy and half because of side effects.
Publisher: Elsevier BV
Date: 09-2008
DOI: 10.1016/J.APMR.2008.04.009
Abstract: Musculoskeletal conditions often manifest with the onset of pain and the resulting physical limitations. Musculoskeletal pain is almost inevitable in an in idual's lifetime. It is one of the most common reasons for self-medication and entry into the health care system. Musculoskeletal pain affects 1 in 4 adults and is the most common source of serious long-term pain and physical disability. The monumental impact of musculoskeletal conditions is now recognized by the United Nations, the World Health Organization, World Bank, and numerous governments throughout the world through support of the Bone and Joint Decade 2000 to 2010 initiative. In iduals with musculoskeletal pain concerns are regularly ignored, their complaints often misunderstood by health care providers, and accordingly they do not receive timely or effective treatment. The standards of care in this document are designed to provide generic guidelines for appropriate care of people with acute or chronic musculoskeletal pain. This document was developed over a 4-year period using multiple international meetings and a Task Force of the Bone and Joint Decade for developing international standards for the care of acute and chronic musculoskeletal pain. The final document is a product of the World Health Organization Collaborating Centre for Evidence-Based Health Care in Musculoskeletal Disorders.
Publisher: Wiley
Date: 10-1975
DOI: 10.1111/J.1365-2125.1975.TB00553.X
Abstract: A clinical trial of phenylbutazone in high dose (300 mg daily) and low dose (50 mg daily) is presented. 2. By analysis of the data by different methods, significant differences in clinical efficacy were shown between the two therapeutic regimes. 3. A relationship between the clinical effect and plasma level of phenylbutazone was demonstrated. 4. Some problems in the interpretation of plasma level-clinical effect correlates are discussed.
Publisher: The Journal of Rheumatology
Date: 04-2014
Abstract: The “Discrimination” part of the OMERACT Filter asks whether a measure discriminates between situations that are of interest. “Feasibility” in the OMERACT Filter encompasses the practical considerations of using an instrument, including its ease of use, time to complete, monetary costs, and interpretability of the question(s) included in the instrument. Both the Discrimination and Reliability parts of the filter have been helpful but were agreed on primarily by consensus of OMERACT participants rather than through explicit evidence-based guidelines. In Filter 2.0 we wanted to improve this definition and provide specific guidance and advice to participants.
Publisher: Proceedings of the National Academy of Sciences
Date: 29-08-2023
Abstract: Targeted inhibitors of bromodomain and extraterminal (BET)-bromodomains and phosphatidylinositol-3-kinase (PI3K) signaling demonstrate potent but self-limited antilymphoma activity as single agents in the context of cellular Myelocytomatosis ( cMYC ) oncogene-dysregulation. However, combined PI3K and BET inhibition imparts synergistic anticancer activity with the potential for more sustained disease responses due to the mutual antagonism of compensatory epigenetic and signaling networks. Here, we describe the mechanistic and therapeutic validation of rationally designed dual PI3K/BET bromodomain inhibitors, built by linkage of established PI3K and BET inhibitor pharmacophores. The lead candidate demonstrates high selectivity, nanomolar range cellular potency, and compelling in vivo efficacy, including curative responses in the aggressive Eµ- Myc lymphoma model. These studies further support the therapeutic strategy of combined PI3K and BET inhibition and provide a potential step-change in approach to orthogonal MYC antagonism using optimized chimeric small-molecule technology.
Publisher: Wiley
Date: 07-2013
DOI: 10.1111/IMJ.12197
Abstract: The patient's role as the key to medical student education was enunciated by Osler in 1903 and remains central to the broader imperative of interprofessional education. Interprofessional education needs to progress from the patient's passive bedside or office role to assume a more active and primary role by his/her participation as the teacher, immersed in student education. To date, the achievements in interprofessional education have been limited, but ambulatory patient-centred learning opportunities involving direct student to patient dialogues and mixed health professional student engagement with patients as teachers are emerging within various interprofessional student clinic formats. There is good evidence that such approaches lead to actual improvements in patient outcomes.
Publisher: Informa Healthcare
Date: 1990
DOI: 10.1185/03007999009112691
Abstract: A randomized study was performed on 24 patients with ankylosing spondylitis to compare the efficacy and tolerability of 20 mg tenoxicam daily with 50 mg diclofenac twice daily. There were 6 withdrawals from the group taking tenoxicam and 4 from the diclofenac group. Depression in 1 patient taking tenoxicam was the only significant adverse event. Both drugs were otherwise well tolerated. Tenoxicam and diclofenac were rated as good or excellent by 27% and 55% of patients, respectively. Global assessment, pain and duration of morning stiffness were improved with both drugs but this improvement was not statistically significant and there was no statistically significant difference between the two groups. This study confirms that tenoxicam is effective and well tolerated but larger numbers would be required to detect a small difference between groups.
Publisher: Wiley
Date: 12-1978
Publisher: Springer Science and Business Media LLC
Date: 07-1990
DOI: 10.1007/BF02274840
Publisher: Springer Science and Business Media LLC
Date: 1982
DOI: 10.2165/00003088-198207010-00005
Abstract: The protein binding of 4 non-steroidal anti-inflammatory drugs and warfarin was investigated in 10 patients with rheumatoid arthritis and in a matched control group of patients with osteoarthritis. There were no differences between the groups in the free fractions of the 5 drugs studied. Fluorescent probe studies also showed only minor differences between groups. The results do not support previous suggestions that drug protein binding is altered in rheumatoid arthritis. Albumin concentration was positively correlated with the binding of salicylate, but not with binding of the other 4 drugs. Fatty acid concentration was directly correlated with the binding of warfarin and indomethacin. Correlations between drugs with respect to protein binding were investigated, but only that between salicylate and ibuprofen was significant.
Publisher: AMPCo
Date: 02-2011
DOI: 10.5694/J.1326-5377.2011.TB04190.X
Abstract: To respond to changing population and workforce needs and expectations, evidence must inform policy investment, implementation and evaluation.
Publisher: Elsevier BV
Date: 08-2008
DOI: 10.1016/J.BERH.2008.07.003
Abstract: Musculoskeletal conditions are an increasingly common problem across the globe due to increased longevity and increased exposure to risk factors such as obesity and lack of physical activity. The increase is predicted to be greatest in developing countries, and there is thus an urgent need for the implementation of strategies and policies that will prevent and control these conditions. The ideal is modification of the risk factors in the whole community, and this will have wide-ranging health benefits as these risk factors are common to other major conditions. Changing people's behaviour is a challenge targeting those at highest risk is potentially more effective, providing that there are both affordable ways of identifying those at risk and affordable interventions. Early intervention in those with a condition such as rheumatoid arthritis is probably the most cost-effective approach, but requires diagnostic capacity--in clinical skills and/or technology--as well as access to care. There is now much evidence for what can be achieved, but the challenge is how to implement these different strategies in developing countries where there are competing priorities for limited resources. The key strategy is to raise awareness among the public, health professionals, and policy makers of the importance of musculoskeletal health, of what can be achieved by prevention and treatment, and to ensure that policies reflect this. It is also necessary to educate the public to know when to seek care, and health-care workers to recognize the early signs of musculoskeletal conditions.
Publisher: Springer Science and Business Media LLC
Date: 06-1999
DOI: 10.1007/BF02918382
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.JCLINEPI.2013.11.013
Abstract: Lack of standardization of outcome measures limits the usefulness of clinical trial evidence to inform health care decisions. This can be addressed by agreeing on a minimum core set of outcome measures per health condition, containing measures relevant to patients and decision makers. Since 1992, the Outcome Measures in Rheumatology (OMERACT) consensus initiative has successfully developed core sets for many rheumatologic conditions, actively involving patients since 2002. Its expanding scope required an explicit formulation of its underlying conceptual framework and process. Literature searches and iterative consensus process (surveys and group meetings) of stakeholders including patients, health professionals, and methodologists within and outside rheumatology. To comprehensively s le patient-centered and intervention-specific outcomes, a framework emerged that comprises three core "Areas," namely Death, Life Impact, and Pathophysiological Manifestations and one strongly recommended Resource Use. Through literature review and consensus process, core set development for any specific health condition starts by identifying at least one core "Domain" within each of the Areas to formulate the "Core Domain Set." Next, at least one applicable measurement instrument for each core Domain is identified to formulate a "Core Outcome Measurement Set." Each instrument must prove to be truthful (valid), discriminative, and feasible. In 2012, 96% of the voting participants (n=125) at the OMERACT 11 consensus conference endorsed this model and process. The OMERACT Filter 2.0 explicitly describes a comprehensive conceptual framework and a recommended process to develop core outcome measurement sets for rheumatology likely to be useful as a template in other areas of health care.
Publisher: Elsevier BV
Date: 06-2014
Publisher: Wiley
Date: 04-1984
DOI: 10.1111/J.1365-2125.1984.TB02363.X
Abstract: The disposition of total and free prednisolone has been studied in four male and four female volunteers, each of whom received an intravenous dose of 0.075 mg/kg (low) and 1.5 mg/kg (high) of prednisolone at both 06.00 h and 18.00 h. For the low dose, free prednisolone clearance was 14% lower (P = 0.012) and time-averaged prednisolone free fraction was 22% higher (P less than 0.001) in the morning, there being no circadian difference in total prednisolone clearance. There was no circadian differences in prednisolone disposition at the high dose. These findings are consistent with a mechanism in which cortisol causes a simultaneous competitive inhibition of prednisolone clearance and plasma protein binding at low, but not at high prednisolone doses. Prednisolone clearance was higher in female than in male subjects, the mean increase being 18% (P = 0.022) for total prednisolone and 21% (P = 0.036) for free prednisolone. Mean total prednisolone clearance and steady-state distribution volume were two-fold higher at the high vs the low dose (P less than 0.001), but free prednisolone clearance showed a dose dependent decrease of 11% (P = 0.019). There was no change in free prednisolone steady-state distribution volume.
Publisher: Elsevier BV
Date: 12-1982
DOI: 10.1016/0006-2952(82)90286-6
Abstract: The protein binding of GP53,633 [2-tert. butyl-4(5)-phenyl-5(4)-(3-pyridyl)-imidazole], a basic non-steroidal anti-inflammatory drug (NSAID), has been investigated. Although GP53,633 is a base (PKa 6.4) rather than an acid, the binding in plasma or serum was totally accounted for by binding to albumin. Scatchard analysis of the binding to albumin suggested the presence of one high affinity site and a number of low affinity sites. GP53,633 and its major metabolite, CGP8716, displaced site-I fluorescent probes (DNSA and warfarin) but not the site-II probe dansylsarcosine. Binding studies by equilibrium dialysis showed that GP53,633 and its metabolite displaced site-I drugs but not site-II drugs, and 14C-GP53,633 was itself displaced by site-I but not site-II drugs. As with other site-I drugs, the binding of GP53,633 was enhanced by addition of oleic acid at molar ratios of up to 2:1 with albumin. Albumin binding of GP53,633 was markedly increased by raising the pH from 6.0 to 8.5 suggesting that only the unionised drug can bind at site-I. The data are consistent with the major part of the binding energy at site-I being due to hydrophobic interactions and also suggest that there is a cationic centre on the protein at or near site-I which precludes the binding of positively charged drugs.
Publisher: Springer Science and Business Media LLC
Date: 1988
DOI: 10.1007/BF00541349
Abstract: The main aim of diabetic nephropathy monitoring is to identify molecular markers, that is, to find changes occurring at metabolome and proteome levels indicative of the disease's development. The mass spectrometry methods available today have been successfully applied to this field. This paper provides a short description of the basic aspects of the mass spectrometric methods used for diabetic nephropathy monitoring, reporting and discussing the results obtained using different approaches.
Publisher: Springer Science and Business Media LLC
Date: 27-08-2018
DOI: 10.1007/S00586-018-5721-Y
Abstract: The purpose of this report is to describe the development of an evidence-based care pathway that can be implemented globally. The Global Spine Care Initiative (GSCI) care pathway development team extracted interventions recommended for the management of spinal disorders from six GSCI articles that synthesized the available evidence from guidelines and relevant literature. Sixty-eight international and interprofessional clinicians and scientists with expertise in spine-related conditions were invited to participate. An iterative consensus process was used. After three rounds of review, 46 experts from 16 countries reached consensus for the care pathway that includes five decision steps: awareness, initial triage, provider assessment, interventions (e.g., non-invasive treatment invasive treatment psychological and social intervention prevention and public health specialty care and interprofessional management), and outcomes. The care pathway can be used to guide the management of patients with any spine-related concern (e.g., back and neck pain, deformity, spinal injury, neurological conditions, pathology, spinal diseases). The pathway is simple and can be incorporated into educational tools, decision-making trees, and electronic medical records. A care pathway for the management of in iduals presenting with spine-related concerns includes evidence-based recommendations to guide health care providers in the management of common spinal disorders. The proposed pathway is person-centered and evidence-based. The acceptability and utility of this care pathway will need to be evaluated in various communities, especially in low- and middle-income countries, with different cultural background and resources. These slides can be retrieved under Electronic Supplementary Material.
Publisher: Wiley
Date: 06-1983
Abstract: Forty elderly (greater than or equal to 60 years old) and 101 young (less than 60 years old) rheumatoid arthritis patients receiving injectable gold therapy were followed prospectively between April 1971 and April 1982. The mean total gold compound received was 1,392 mg in the young group and 1,861 in the elderly group. Besides age, the only significant difference between the two groups was the increased gold compound received by the elderly. To determine efficacy and toxicity within and between certain age groups, the 141 patients were ided into 4 arbitrary age groups: group A (less than 30 years), group B (30-44 years), group C (45-59 years), and group D (greater than or equal to 60 years). The elderly responded to the gold therapy as well as the young patients did, at any time frame examined after 3 months of therapy. There was no difference in clinical benefit among groups A, B, C, and D. Nine patients in the elderly group and 15 in the young group had therapy discontinued because of no response. This difference was not significant among the groups A, B, C, and D. There was no difference in outcome of in idual toxicity between the elderly and the young groups, and no difference in frequency of toxicity between the age groups A, B, C, and D. Serious hematologic toxicity occurred only in patients over 47 years of age, and nephrotic syndrome occurred only in patients over 52. In this study, gold therapy was found to be as clinically beneficial in the elderly as in the young patients, and the toxicity and drug failure rates were not significantly different.
Publisher: Wiley
Date: 02-1975
DOI: 10.1111/J.1365-2362.1975.TB00431.X
Abstract: This study was designed to investigate the respective roles of H(1) and H(2) receptors in the control of the microcirculation by examining the effectiveness of the H(2) receptor antagonist metiamide (Met.) and H(1) receptor antagonist mepyramine is blocking the action of histamine on synovial perfusion. Synovial perfusion was monitored indirectly by calculating the half-life (T1/2 min.) of the clearance rate of 133-Xe from canine diarthrodial joints. The 133-Xe clearance rate, unaffected by metiamide alone, was consistently increased by histamine alone. Metiamide produced a dose related effect on the histamine response with consistent abolition of response at high dose ratios of metiamide to histamine variable response at intermediate and a pronounced histamine response at low dose ratios. Mepyramine produced no such antagonism of the histamine response and in certain doses, by itself caused an increase in 133-Xe clearance rate. This effect of mepyramine was thought to be related to its histamine releasing properties a view supported by the reduction in this vasodilator response following certain doses of metiamide. The response of the 133-Xe clearance rate to histamine returned approximately one hour after treatment with metiamide (500 mug) and metiamide did not antagonise the effects of alpha and beta adrenergic agents on the 133-Xe clearance rate. Thus, this study has provided evidence for the presence of H(2) but not H(1) receptors in the synovial microcirculation.
Publisher: CSIRO Publishing
Date: 2010
DOI: 10.1071/PY09060
Abstract: Australia is facing a primary health care workforce shortage. To inform primary health care (PHC) workforce policy reforms, reflection is required on ways to strengthen the evidence base and its uptake into policy making. In 2008 the Australian Primary Health Care Research Institute funded the Australian Health Workforce Institute to host Professor James Buchan, Queen Margaret University, UK, an expert in health services policy research and health workforce planning. Professor Buchan’s visit enabled over forty Australian PHC workforce mid-career and senior researchers and policy stakeholders to be involved in roundtable policy dialogue on issues influencing PHC workforce policy making. Six key thematic questions emerged. (1) What makes PHC workforce planning different? (2) Why does the PHC workforce need to be viewed in a global context? (3) What is the capacity of PHC workforce research? (4) What policy levers exist for PHC workforce planning? (5) What principles can guide PHC workforce planning? (6) What incentives exist to optimise the use of evidence in policy making? The emerging themes need to be discussed within the context of current PHC workforce policy reforms, which are focussed on increasing workforce supply (via education/training programs), changing the skill mix and extending the roles of health workers to meet patient needs. With the Australian government seeking to reform and strengthen the PHC workforce, key questions remain about ways to strengthen the PHC workforce evidence base and its uptake into PHC workforce policy making.
Publisher: Elsevier BV
Date: 08-1975
DOI: 10.1016/0002-9378(75)90724-3
Abstract: Serum concentration of radioimmunoreactive gastrin reflects closely the known physiology of gastric acid secretion during pregnancy. In particular, marked rises of immunoreactive gastrin occur in late pregnancy, at parturition, and in the early puerperium.
Publisher: BMJ
Date: 1988
DOI: 10.1136/ARD.47.5.377
Abstract: Synovial fluid from 201 normal and pathological knee joints was subjected to gel filtration by Sepharose CL-2B chromatography to separate hyaluronic acid (HA) from unbound proteins, which were retarded on this column. HA from all normal fluids was excluded from the gel and contained 1% or less bound protein. Synovial fluids taken from joints of patients with rheumatoid arthritis (RA) contained considerably more protein bound to HA. In 46% of RA s les the level of protein was greater than 4%, whereas only one fluid examined from osteoarthritic joints contained this amount. The proteins bound to HA from RA joints were identified by sodium dodecyl sulphate olyacrylamide gel electrophoresis (SDS-PAGE) and immunodiffusion techniques as the acute phase proteins alpha 1 proteinase inhibitor, inter-alpha-trypsin inhibitor, and haptoglobin. The average relative percentages of these proteins bound to HA were 17.6%, 32.6%, and 29.2% respectively. These HA-protein complexes could be generated in vitro by mixing normal (low protein) HA with any one of the three acute phase proteins. The HA-protein complexes formed in vitro with inter-alpha-trypsin inhibitor or haptoglobin, and those isolated from RA synovial fluids, were more resistant to degradation by oxygen derived free radicals (ODFR) than HA from normal fluids. From these findings we conclude that certain acute phase proteins diffusing into synovial fluid during inflammatory episodes may play an important part in protecting HA from depolymerisation by activated phagocytes.
Publisher: Wiley
Date: 06-1984
DOI: 10.1111/J.1365-2125.1984.TB02400.X
Abstract: The disposition of total and free prednisolone has been studied in eight female subjects who used combined oestrogen-progestogen oral contraceptives and in eight female subjects who did not, each of whom received separate intravenous doses of 0.1 mg/kg (low) and 1.0 mg/kg (high) of prednisolone. Mean free prednisolone clearance was reduced congruent to 30% in oral contraceptive users compared to control subjects (P less than 0.001), the difference being greater for the low dose (39%) than for the high dose (24%). Pre-dose plasma cortisol concentrations were elevated two-fold (P less than 0.001) in oral contraceptive users compared to control subjects. These effects are consistent with a mechanism in which the competitive inhibition of free prednisolone clearance by cortisol contributes to the reduction of free prednisolone clearance by oral contraceptive use. Mean total prednisolone clearance and steady state distribution volume showed an approximate two-fold dose dependent increase consistent with a similar increase in plasma prednisolone free fraction (P less than 0.001). Free prednisolone clearance showed an 18% dose dependent decrease (P less than 0.001) but free steady-state distribution volume did not change with dose. At plasma prednisolone concentrations less than 400 ng/ml, prednisolone free fractions at any prednisolone concentration were greater after the low, than after the high dose. This effect is consistent with the displacement of prednisolone by cortisol from transcortin but not from albumin.
Publisher: AMPCo
Date: 02-2008
Publisher: BMJ
Date: 18-02-2014
DOI: 10.1136/ANNRHEUMDIS-2013-204344
Abstract: The objective of this paper is to provide an overview of methods used for estimating the burden from musculoskeletal (MSK) conditions in the Global Burden of Diseases 2010 study. It should be read in conjunction with the disease-specific MSK papers published in Annals of Rheumatic Diseases. Burden estimates (disability-adjusted life years (DALYs)) were made for five specific MSK conditions: hip and/or knee osteoarthritis (OA), low back pain (LBP), rheumatoid arthritis (RA), gout and neck pain, and an 'other MSK conditions' category. For each condition, the main disabling sequelae were identified and disability weights (DW) were derived based on short lay descriptions. Mortality (years of life lost (YLLs)) was estimated for RA and the rest category of 'other MSK', which includes a wide range of conditions such as systemic lupus erythematosus, other autoimmune diseases and osteomyelitis. A series of systematic reviews were conducted to determine the prevalence, incidence, remission, duration and mortality risk of each condition. A Bayesian meta-regression method was used to pool available data and to predict prevalence values for regions with no or scarce data. The DWs were applied to prevalence values for 1990, 2005 and 2010 to derive years lived with disability. These were added to YLLs to quantify overall burden (DALYs) for each condition. To estimate the burden of MSK disease arising from risk factors, population attributable fractions were determined for bone mineral density as a risk factor for fractures, the occupational risk of LBP and elevated body mass index as a risk factor for LBP and OA. Burden of Disease studies provide pivotal guidance for governments when determining health priority areas and allocating resources. Rigorous methods were used to derive the increasing global burden of MSK conditions.
Publisher: BMJ
Date: 24-04-2014
Publisher: CSIRO Publishing
Date: 30-01-2023
DOI: 10.1071/AH22236
Abstract: In this article, we examine the role and effectiveness of the Centers for Disease Control and Prevention in the USA and Europe and consider possible lessons for future pandemic planning in Australia. We also ‘map’ the interjurisdictional communication pathways that have been secured since the election of the new Commonwealth government. We suggest a number of steps that could be taken to upgrade the collection, distribution, accessibility and timelines of key information required to improve pandemic management and national health outcomes. While it may be hard to contemplate a move to a fully integrated National capacity when we are only just emerging from the pandemic, we do have a unique opportunity to at least start the process of review. We should use the lessons we have learned to transform our systems, rather than ‘tinker’ with them and ensure we are better prepared for next time.
Publisher: Wiley
Date: 21-03-2013
DOI: 10.1111/JPC.12157
Abstract: To determine if the duration of general practitioner (GP) consultations, or the proportional distribution of item numbers associated with longer consultations, with children has changed in association with the demographic changes in Australia. Secondary data analysis of Medicare claims from 1996 to 2010, which were stratified by patient age and visit type as designated by billing item number, and of the Bettering the Evaluation of Care and Health (BEACH) database was conducted. The Medicare data that were analysed were changes in overall proportion and absolute numbers of longer consultations for children from 1996 to 2010, while the BEACH data that were analysed were changes in the average duration of visits for children and the proportion of visits by children for chronic conditions. Despite the increase in the population of children, and the increasing numbers of children with chronic illness, the absolute number of longer consultations for children has decreased over the time period studied. Further, the proportion of all longer consultations that are being provided to children has diminished. For those consultations that do occur, the GPs are not spending any more time with children in 2010 than they did in consultations in 2000. There have been significant changes in the patterns of longer consultations provided to children by GPs. Efforts to ensure that children receive primary care for chronic conditions and preventive care must now take on a greater urgency for the health-care system.
Publisher: Oxford University Press (OUP)
Date: 1989
DOI: 10.1093/RHEUMATOLOGY/28.1.13
Abstract: As an intermediate stage in the development of an expert system to support undergraduate teaching in rheumatology, a decision tree incorporating the diagnostic criteria to be used in the expert system was produced by a team of rheumatologists. In a controlled trial, 119 final-year medical students each diagnosed 10 rheumatology cases, drawn from a pool of 96 cases, with or without the aid of the decision tree. Students who used the decision tree correctly diagnosed the following conditions more frequently than the control group: polymyalgia rheumatica (p less than 0.05), myopathies (p less than 0.01), systemic lupus erythematosus (p less than 0.05), pyrophosphate arthropathy (p less than 0.05), seronegative spondylarthropathies (p less than 0.01), intra-articular bleeding (p less than 0.05) and traumatic synovitis (p less than 0.05). The overall diagnostic accuracy of the students who used the decision tree was 81% compared with 68% for the control group (p less than 0.001).
Publisher: Springer Science and Business Media LLC
Date: 2006
Publisher: Wiley
Date: 04-1975
DOI: 10.1111/J.1365-2125.1975.TB01567.X
Abstract: 1 The effects of various anti-inflammatory and non-anti-inflammatory drugs on complement mediated haemolysis have been studied. Drugs which were significantly protein bound were found to inhibit this form of immune lysis, but only at greater concentrations than achieved therapeutically. 2 Removal of the drugs by prolonged dialysis resulted in restoration of complement activity with the exceptions of phenylbutazone and warfarin sodium. 3 Reconstitution experiments indicated that C2 and some of the later components especially C7 were affected by the drugs. 4 Intra-articular injections of prednisolone (100 mg) in patients with rheumatoid arthritis, failed to produce significant changes in the synovial fluid complement system. 5 None of the drugs affected the binding of antibody to antigen, or the ability of sensitized sheep cells to fix complement.
Publisher: Wiley
Date: 07-2013
DOI: 10.5694/MJA12.10069
Abstract: Health systems with strong primary care orientations are known to be associated with improved equity, better access for patients to appropriate services at lower costs, and improved population health. Team-based models of primary care have emerged in response to health system challenges due to complex patient profiles, patient expectations and health system demands. Successful team-based models of primary care require a combination of interprofessional education and learning organisational and management policies and systems and practice support systems. To ensure evidence is put into practice, we propose a framework comprising five domains (theory, implementation, infrastructure, sustainability and evaluation) to assist policymakers, educators, researchers, managers and health professionals in supporting team-based models of primary care within the Australian health care system.
Publisher: Springer Science and Business Media LLC
Date: 04-2008
DOI: 10.2165/01312067-200801020-00005
Abstract: To assess the relationship between fatigue and health-related quality of life (HR-QOL) among people with osteoarthritis (OA) and rheumatoid arthritis (RA). Community-dwelling people with OA, and OA patients on the waiting list for joint replacement surgery, were recruited. RA patients were recruited from rheumatologists' public and private outpatient clinics. Respondents completed a questionnaire containing demographic detail, the Fatigue Severity Scale (FSS), the Multidimensional Assessment of Fatigue (MAF), the SF-36, Western Ontario and McMaster Universities Osteoarthritis Index, and the Health Assessment Questionnaire (HAQ). There were 137 OA and 52 RA respondents. Neither age nor sex was significantly associated with fatigue for OA or RA. The mean FSS score was 3.36 for RA and 3.63 for OA. Fifty percent of respondents with RA and 58% of those with OA met the FSS >3 cut-point for fatigue. Mean MAF Global Fatigue Index was 20.8 for OA and 20.1 for RA. Correlations between health status and fatigue indicated that for both OA and RA those with greater fatigue reported worse health status. Few studies have measured the impact of fatigue among respondents with OA, despite it affecting a large proportion of the population. Fatigue was significantly correlated with poorer HR-QOL among OA respondents, suggesting that fatigue is a significant issue in OA as well as RA.
Publisher: CSIRO Publishing
Date: 2016
DOI: 10.1071/AH15014
Abstract: People with chronic complex conditions continue to experience increasing health system fragmentation and poor coordination. To reverse these trends, one solution has been an investment in effective models of care coordination that use a care coordinator workforce. Care coordinators are not a homogenous workforce – but an applied professional role, providing direct and indirect care, and is often undertaken by nurses, allied health professionals, social workers or general practitioners. In Australia, there is no training curriculum nor courses, nor nationally recognised professional quality standards for the care coordinator workforce. With the growing complexity and fragmentation of the health care system, health system literacy – shared understanding of the roles and contributions of the different workforce professions, organisations and systems, among patients and indeed the health workforce is required. Efforts to improve health system literacy among the health workforce are increasing at a policy, practice and research level. However, insufficient evidence exists about what are the health system literacy needs of care coordinators, and what is required for them to be most effective. Key areas to build a health system literate care coordination workforce are presented. Care coordination is more than an optional extra, but one of the only ways we are going to be able to provide equitable health services for people with chronic complex conditions. People with low health literacy require more support with the coordination of their care, therefore we need to build a high performing care coordinator workforce that upholds professional quality standards, and is health literacy responsive.
Publisher: CSIRO Publishing
Date: 2008
DOI: 10.1071/AH080156
Abstract: Health workforce reform remains a major challenge for Australia. The recent Productivity Commission report provided some guidance, but, sadly, few of the recommendations have been implemented. Health economies (and with them the health workforce) will continue to expand as the burden of disease increases. The important issue is to expand the current workforce but provide for a generalist stream that allows flexibility and retraining. The future health workforce needs to be able to provide patient-centred care, to have a focus on public health and disease prevention, use information and the new communication technologies, to be able to work as part of a team and partner with a range of organisations and to be dedicated to quality improvement within the health system.
Publisher: Oxford University Press (OUP)
Date: 07-1991
DOI: 10.1111/J.1365-2249.1991.TB05695.X
Abstract: The effects of GM-CSF, IL-2, IFN-γ, TNF-α and IL-6 on the production of IL-1 (both secreted and cell associated) and TNF-α by peripheral blood monocytes were studied. Monocytes were cultured for 20 h in suspension and in serum-free conditions which minimized background stimulation of monokine production. GM-CSF, IL-2 and TNF-α directly induced the production of cell-associated IL-1 but little or no IL-1 or TNF-α secretion. Combination of GM-CSF with IFN-γ, IL-2 or TNF-α synergistically enhanced IL-1 secretion and had an additive effect on cell-associated IL-1 production. Combination of IL-2 with IFN-γ or TNF-α also synergistically enhanced IL-1 secretion but the effect on cell-associated IL-1 production was less than additive. GM-CSF synergisticaily enhanced TNF-α secretion induced by IFN-γ but not by tipopolysaccharide. GM-CSF did not enhance TNF-α secretion induced by IL-2 or TNF-α. In contrast, IL-2 synergistically enhanced TNF-α secretion induced by IFN-γ. These results are discussed in relation to cytokine involvement in rheumatoid arthritis.
Publisher: Oxford University Press (OUP)
Date: 04-1999
DOI: 10.1093/RHEUMATOLOGY/38.4.321
Abstract: Autologous haemopoietic stem cell transplantation (HSCT), which carries defined risks of early treatment-related mortality (TRM), has recently been proposed as an experimental therapy for severe rheumatoid arthritis (RA). The aim of this study was to establish whether the risks of this approach are acceptable to patients with RA and whether risk taking related to disease-associated or personal/social parameters. A standard gamble questionnaire was used to determine the acceptable risk of mortality for a potentially curative procedure in patients with RA aged 0.44 (84% of our s le), but allogeneic HSCT (with a TRM of 13.1%) would be acceptable only to severely disabled patients with HAQ scores of >2.45 (4% of our s le), assuming the procedure to be curative. Along with previous studies, these results suggest that, if long-term efficacy can be proven, then the risks of autografting may be acceptable to most patients with RA, particularly those with significant disability.
Publisher: BMJ
Date: 03-02-2011
Abstract: Remission in rheumatoid arthritis (RA) is an increasingly attainable goal, but there is no widely used definition of remission that is stringent but achievable and could be applied uniformly as an outcome measure in clinical trials. This work was undertaken to develop such a definition. A committee consisting of members of the American College of Rheumatology, the European League Against Rheumatism, and the Outcome Measures in Rheumatology Initiative met to guide the process and review prespecified analyses from RA clinical trials. The committee requested a stringent definition (little, if any, active disease) and decided to use core set measures including, as a minimum, joint counts and levels of an acute-phase reactant to define remission. Members were surveyed to select the level of each core set measure that would be consistent with remission. Candidate definitions of remission were tested, including those that constituted a number of in idual measures of remission (Boolean approach) as well as definitions using disease activity indexes. To select a definition of remission, trial data were analysed to examine the added contribution of patient-reported outcomes and the ability of candidate measures to predict later good radiographic and functional outcomes. Survey results for the definition of remission suggested indexes at published thresholds and a count of core set measures, with each measure scored as 1 or less (eg, tender and swollen joint counts, C reactive protein (CRP) level, and global assessments on a 0–10 scale). Analyses suggested the need to include a patient-reported measure. Examination of 2-year follow-up data suggested that many candidate definitions performed comparably in terms of predicting later good radiographic and functional outcomes, although 28-joint Disease Activity Score–based measures of remission did not predict good radiographic outcomes as well as the other candidate definitions did. Given these and other considerations, we propose that a patient's RA can be defined as being in remission based on one of two definitions: (1) when scores on the tender joint count, swollen joint count, CRP (in mg/dl), and patient global assessment (0–10 scale) are all ≤1, or (2) when the score on the Simplified Disease Activity Index is ≤3.3. We propose two new definitions of remission, both of which can be uniformly applied and widely used in RA clinical trials. The authors recommend that one of these be selected as an outcome measure in each trial and that the results on both be reported for each trial.
Publisher: Oxford University Press (OUP)
Date: 11-2000
DOI: 10.1093/RHEUMATOLOGY/39.11.1242
Abstract: To determine whether patients with osteoarthritis (OA) would be willing to pay for joint replacement and whether patient characteristics or health outcomes, including pain, physical function and health-related quality of life, were related to willingness to pay (WTP). Patients who had undergone primary total hip replacement (THR) or total knee replacement (TKR) for OA completed a disease-specific questionnaire (Western Ontario and McMaster: WOMAC index), a generic measure of health status (Medical Outcome Study Short Form-36: SF-36) and an Evaluation Questionnaire to measure WTP and satisfaction with the replacement. Responses were obtained from 109 (77%) THR patients and 129 (72%) TKR patients. Mean age of respondents was 67 yr for THR (47% female) and 73 yr for TKR (60% female). Overall, 85% of patients responded to the WTP question. Of the THR patients, 71% were willing to pay something, 11% were not willing to pay anything and 18% did not answer the question. For TKR patients these figures were 70, 16 and 14% respectively. However, of those who responded to the WTP question, only 25% of the THR patients and 18% of the TKR patients indicated they would be willing to pay the actual current average cost of the operation in Australia (>/= A$15 000). A lower postoperative pain score (as measured by the WOMAC index) was a significant predictor of WTP for both THR and TKR patients. Income also significantly predicted WTP in THR patients but not in TKR patients. The other significant predictors for TKR patients were older age, having private health insurance and willingness to recommend joint replacement to others. Willingness to pay was a measure that was understandable and acceptable to patients, most of whom were willing to pay something. There was a high correlation between WTP, good health outcomes and patient satisfaction, pain relief being the dominant determinant.
Publisher: AMPCo
Date: 1980
DOI: 10.5694/J.1326-5377.1980.TB134572.X
Abstract: Forty patients with arthritis (26 rheumatoid and 14 osteoarthrosis) entered a five-week double-blind crossover trial of diclofenac and ibuprofen. Four patients failed to complete the 10-week trial. There was no statistically significant difference in parameters of disease activity for the rheumatoid arthritis patients, but patients with osteoarthrosis fared significantly better on diclofenac. There was a low incidence of side effects on both regimens.
Publisher: Informa Healthcare
Date: 1974
DOI: 10.1185/03007997409114766
Abstract: Pyogenic granuloma is a benign vascular tumor that may affect the gastrointestinal tract. This report describes a rare case of sigmoid-colon pyogenic granuloma in a 4-month-old boy causing intussusception. Resection and anastomosis were curative. The mother had history of high dose of progesterone exposure during initial weeks of conception for vaginal bleeding. This may point towards etiology of the lesion.
Publisher: AMPCo
Date: 02-1971
DOI: 10.5694/J.1326-5377.1971.TB87662.X
Abstract: Refractory hypertension is a recently described phenotype of antihypertensive treatment failure defined as uncontrolled blood pressure (BP) despite the use of ≥5 different antihypertensive agents, including chlorthalidone and spironolactone. Recent studies indicate that refractory hypertension is uncommon, with a prevalence of ≈5% to 10% of patients referred to a hypertension specialty clinic for uncontrolled hypertension. The prevalence of white-coat effect, that is, uncontrolled automated office BP ≥135/85 mm Hg and controlled out-of-office BP <135/85 mm Hg, by awake ambulatory BP monitor in hypertensive patients overall is ≈30% to 40%. The prevalence of white-coat effect among patients with refractory hypertension has not been previously reported. In this prospective evaluation, consecutive patients referred to the University of Alabama at Birmingham Hypertension Clinic for uncontrolled hypertension were enrolled. Refractory hypertension was defined as uncontrolled automated office BP ≥135/85 mm Hg with the use of ≥5 antihypertensive agents, including chlorthalidone and spironolactone. Automated office BP measurements were based on 6 serial readings, done automatically with the use of a BpTRU device unobserved in the clinic. Out-of-office BP measurements were done by 24-hour ambulatory BP monitor. Thirty-four patients were diagnosed with refractory hypertension, of whom 31 had adequate ambulatory BP monitor readings. White-coat effect was present in only 2 patients, or 6.5% of the 31 patients with refractory hypertension, suggesting that white-coat effect is largely absent in patients with refractory hypertension. These findings suggest that white-coat effect is not a common cause of apparent lack of BP control in patients failing maximal antihypertensive treatment.
Publisher: SAGE Publications
Date: 12-2005
DOI: 10.1177/17423953050010041101
Abstract: Objectives: To analyse the differences in patient health outcomes and out-of-pocket costs following hip and knee joint replacement for osteoarthritis between patients who went home immediately after the acute care hospital stay and those who were admitted to inpatient rehabilitation care before going home. Methods: One hundred and eighteen patients undergoing total hip or knee replacement in Sydney, Australia completed cost diaries, SF-36 and WOMAC Index, pre-operatively and for one year post-operatively. Results: The health status of all groups improved significantly from before surgery to 12 months post-surgery. No significant difference in health status at 12 months post-surgery was seen between home and rehabilitation patients for either hip or knee replacement. Both hip replacement home and rehabilitation patients and knee replacement home patients reported lower out-of-pocket expenditure from before surgery to 1 year post-surgery. Discussion: The majority of total joint replacement patients can be discharged directly home and achieve excellent outcomes at 12 months post-surgery. We would recommend more focused randomized studies to explore the most suitable patient selection for rehabilitation.
Publisher: Oxford University Press (OUP)
Date: 04-1997
DOI: 10.1093/RHEUMATOLOGY/36.4.470
Abstract: One hundred and thirty-four patients with either osteoarthritis or rheumatoid arthritis, and with a history of current or past non-steroidal anti-inflammatory drug (NSAID) treatment, were interviewed regarding the benefits, expectations and side-effects of NSAID therapy. Their willingness to accept risks in medical treatment was also evaluated. Both groups experienced positive effects of the NSAID treatment corresponding to their expectations. However, rheumatoid arthritis patients were significantly more willing to accept gastrointestinal side-effects when given an effective NSAID than the osteoarthritis patients, and they were also more willing to take risks in trying a hypothetical new NSAID that had been shown to be effective in clinical trials.
Publisher: AMPCo
Date: 04-1988
DOI: 10.5694/J.1326-5377.1988.TB115964.X
Abstract: A patient-completed questionnaire has been shown to be equivalent to an observer-administered format in discriminating between subjects with and without keratoconjunctivitis sicca. As well as saving time it can screen patients for the presence of keratoconjunctivitis sicca without the need for more specialized and/or invasive techniques.
Publisher: Wiley
Date: 02-1999
DOI: 10.1111/J.1445-5994.1999.TB01586.X
Abstract: Familial systemic sclerosis has been rarely reported. Assumptions have therefore been made implying no familial disease aggregation. This study critically challenges the assumption using a methodical population-based epidemiological approach to quantify the prevalence and characteristics of familial systemic sclerosis. In this retrospective cohort study the systemic sclerosis prevalence in first degree family members was compared between 715 systemic sclerosis patients (710 families) and 371 randomly ascertained age and gender group-matched general practice controls (371 families). These data, obtained by telephone questionnaire (living patients) or medical records review (deceased patients and untraceable patients of unknown living status), were validated, where necessary, and expressed in terms of relative risk, absolute risk and population point prevalence. Systemic sclerosis affecting first degree members was validated in ten of 710 families. Reporting of systemic disease in another four more distant family members, and the co-occurrence of systemic and localised disease in three families was also documented. Observed and expected disease subtype concordance was 80% (44-97%) and 68% respectively and the female predominance among familial cases was similar to that for non-familial disease. The risk of disease in a subsequent first degree relative was compared to the risk in an initial first degree family member. Its estimated magnitude was wide (11-158). However, use of population prevalence data to determine the expected number of systemic sclerosis patients in the negative cohorts' families suggests the higher estimate is more realistic. Despite the high magnitude, the absolute disease risk in first degree family members remained low--approximating 1%. The population prevalence of familial systemic sclerosis approximated 1.4/million. This study substantially increases the otherwise small list of documented instances of familial systemic sclerosis. More importantly, it quantifies the risk for the first time, ranking it as the disease's most powerful determinant identified to date.
Publisher: Springer Science and Business Media LLC
Date: 06-1986
DOI: 10.1007/BF01965007
Abstract: An acute overdosage of 30 mg of pizotifen causing a pyrexial illness is reported. The clinical features suggest that the effects of overdosage are principally due to the anticholinergic activity of this drug. Resolution of symptoms occurred after 10 hours, without specific therapy.
Publisher: Oxford University Press (OUP)
Date: 1994
DOI: 10.1093/RHEUMATOLOGY/33.4.397
Abstract: A 43-yr-old caucasian female presented in July 1992 with an explosive onset of diffuse scleroderma following general anaesthesia for orthopaedic surgery. Her environmental exposures included silicone breast prosthetic surgery and silica exposure, both preceding development of scleroderma. She was DR5-negative, DRw52 positive. All currently available literature relating to breast implants and scleroderma is reviewed and the conclusion drawn that, for currently documented US data, there is no evidence to suggest that patients having had breast augmentation have rates of scleroderma higher than expected to chance alone. However the cause-effect relationship between silicone and scleroderma/other connective tissue disease requires, not just anecdotal reports, but a rigorously designed study.
Publisher: Wiley
Date: 05-1989
Abstract: The rat subcutaneous air pouch model was adapted to examine the in vivo degradation of implanted rabbit articular cartilage, both with and without induced air pouch inflammation, over a 7-day period. The effects of 3 drugs, glycosaminoglycan polysulfate (Arteparon), pentosan polysulfate (SP-54), and zinc-chelated pentosan polysulfate (DH-40J), on inflammation-induced cartilage degradation were also examined. Implanted articular cartilage from noninflamed air pouches showed a reduction in total proteoglycan (PG) content (as hexuronic acid), but not in PG extractability or aggregation, compared with cartilage maintained in tissue culture. The injection of peptone into the air pouch as an inflammogen caused an influx of leukocytes and plasma exudate and a reduction in implanted articular cartilage PG content, extractability, and aggregation, which was significantly greater than that which occurred in noninflamed air pouches. In vitro experiments demonstrated that peptone did not have a direct effect on cartilage PG degradation. Daily injection of Arteparon, SP-54, or DH-40J (10 mg/kg) into peptone-inflamed air pouches significantly increased the PG content, extractability, and aggregation in implanted articular cartilage, compared with that in cartilage from non-drug-treated control animals. The infiltration of leukocytes into the peptone-inflamed air pouches was significantly reduced by daily administration of Arteparon, 10 mg/kg. At an equivalent dose, DH-40J increased leukocyte numbers in the pouch fluid, whereas SP-54 had no significant effect on leukocyte accumulation.
Publisher: Springer Science and Business Media LLC
Date: 06-1983
Abstract: The disposition of diflunisal was studied at daily doses of 250, 500, 750, 1000 mg/day in 24 male patients (mean age 65 yr and mean creatinine clearance 72 ml/min). Each dose was given for 14 days and diflunisal apparent oral clearance and serum urate was measured on the last day of each dosing regimen. There was a dose-dependent decrease in mean diflunisal apparent oral clearance with dose from 628 ml/hr at 250 mg/day to 426 ml/hr at 1000 mg/day, with most of the decrease occurring at the lower doses and becoming less pronounced at doses of 750 and 1000 mg/day. There was a strong positive correlation between diflunisal apparent oral clearance and creatinine clearance. Diflunisal induced a hypouricemic effect at all doses, but the responses at doses of 750 and 1000 mg/day did not differ.
Publisher: Wiley
Date: 06-1987
DOI: 10.1111/J.1445-5994.1987.TB01232.X
Abstract: We have performed the first controlled study of colchicine in acute gout, to determine its efficacy and toxicity, and to define the natural history of acute gout. Two-thirds of colchicine-treated patients improved after 48 hours, but only one-third of the patients receiving placebo demonstrated similar improvement. The colchicine-treated patients responded earlier significant differences from placebo were shown after 18-30 hours. All patients given colchicine developed diarrhea after a median time of 24 hours (mean dose of colchicine 6.7 mg). This side effect occurred before relief of pain in most patients.
Publisher: Elsevier BV
Date: 12-1989
Publisher: CSIRO Publishing
Date: 2011
DOI: 10.1071/AH10934
Abstract: Objective. To review international experience in order to inform Australian PHC workforce policy on the role of primary healthcare organisations (PHCOs/Medicare Locals) in PHC workforce planning. Method. A NZ and UK study tour was conducted by the lead author, involving 29 key informant interviews with regard to PHCOs roles and the effect on PHC workforce planning. Interviews were audio-taped with consent, transcribed and analysed thematically. Results. Emerging themes included: workforce planning is a complex, dynamic, iterative process and key criteria exist for doing workforce planning well PHCOs lacked a PHC workforce policy framework to do workforce planning PHCOs lacked authority, power and appropriate funding to do workforce planning there is a need to align workforce planning with service planning and a PHC Workforce Planning and Development Benchmarking Database is essential for local planning and evaluating workforce reforms. Conclusion. With the Australian government promoting the role of PHCOs in health system reform, reflections from abroad highlight the key action within PHC and PHCOs required to optimise PHC workforce planning.
Publisher: Springer Science and Business Media LLC
Date: 10-1985
DOI: 10.1007/BF01966692
Abstract: Hepatosplenic gamma delta T-cell lymphoma is a rare peripheral T-cell lymphoma of cytotoxic T-cell origin with an aggressive clinical course. Chronic immunosuppression has been proposed as a possible pathogenetic mechanism. No association of hepatosplenic gamma delta T-cell lymphoma with visceral leishmaniasis has been described in the past. We describe a case of an adolescent boy with hepatosplenic gamma delta T-cell lymphoma with leukemic presentation, who was diagnosed to have visceral leishmaniasis, 9 months prior to presentation at our center. To the best of our knowledge this is the first report of hepatosplenic gamma delta T-cell lymphoma with a prior history of visceral leishmaniasis in the medical literature. A 13-year-old Indian boy presented to the hematology out-patient department with a history of progressive abdominal distension of 9 months' duration and low grade fever of 2 months' duration. He was a known case of visceral leishmaniasis and was treated with some clinical improvement in the past. However, his symptoms recurred and he was diagnosed to have hepatosplenic gamma delta T-cell lymphoma at our center. Cytogenetic analysis showed characteristic karyotype of isochromosome 7. Chronic antigen stimulation due to visceral leishmaniasis may have led to an expansion of gamma delta T cells in our patient, and immunophenotypic analysis of bone marrow aspirate and characteristic karyotype helped to achieve the diagnosis. The aim of this case report is to highlight the rare association of hepatosplenic T-cell lymphoma with visceral leishmaniasis.
Publisher: Elsevier BV
Date: 09-1987
DOI: 10.1016/0090-6980(87)90088-8
Abstract: The metabolism in vitro of synthetic leukotriene B4 (LTB4) in synovial fluid from rheumatoid arthritis and osteoarthritis patients and in whole blood from these same patient groups and from normal volunteers has been studied. A linear relationship existed between a plot of the time of incubation of s les with LTB4 and the percentage of the initial concentration of LTB4 at each time point. The slope of this line, the rate constant for metabolism, has been used to compare different s les. LTB4 was metabolised more rapidly in the synovial fluid of rheumatoid arthritis patients than osteoarthritis patients. Furthermore, LTB4 was metabolised more rapidly in the blood of rheumatoid arthritis patients than either osteoarthritis patients or normal volunteers. These differences in metabolism correlate with the polymorphonuclear leukocyte (PMN) and albumin content of s les. It is suggested that binding of LTB4 to albumin in vivo will in part determine the available concentration of LTB4 in inflammatory lesions.
No related grants have been discovered for Peter Brooks.