11 research outputs found
RANCANG BANGUN APLIKASI PENJUALAN DAN INVENTORY PRODUK BERBASIS WEBSITE MENGGUNAKAN METODE AGILE UD BERKAH JAYA ABADI
No full textUD Berkah Jaya Abadi adalah perusahaan konveksi yang menghadapi tantangan dalam pengelolaanpenjualan dan inventori, yang masih dilaksanakan secara manual menggunakan kertas. Proses ini rentanterhadap kesalahan dan kehilangan data, yang menghambat efisiensi operasional perusahaan. Penelitian inibertujuan untuk merancang serta mengembangkan aplikasi berbasis web yang dapat meningkatkan efisiensipencatatan penjualan dan inventori. Pengembangan sistem ini memakai metode pengembangan perangkatlunak Agile, dengan analisis kebutuhan perangkat lunak yang mencakup HTML dan CSS untukpengembangan antarmuka pengguna, PHP sebagai bahasa pemrograman utama, serta framework Laraveluntuk pengelolaan back-end. Sistem ini dirancang untuk mempermudah pencatatan data, meningkatkantransparansi proses penjualan, serta mempercepat pembuatan laporan secara otomatis. Pengujiandilaksanakan memakai metode Black Box Testing guna memastikan aplikasi berfungsi sesuai dengankebutuhan pengguna. Hasil pengembangan memperlihatkan bahwasanya aplikasi ini mampu meningkatkanefisiensi operasional, mempermudah pelacakan transaksi, serta mempercepat proses pembuatan laporan,sehingga memberikan solusi yang efektif bagi UD Berkah Jaya Abadi dalam mengelola penjualan daninventori.Kata kunci : Website, PHP, Laravel, Agile, Black Box Testin
Menajemen Sistem Informasi PT. Telkomsel Plasa
No full textField Work Practice (PKL) is a means of self-actualization of some skills or skills, both soft skills and hard skills that have been acquired during lectures, applied in an agency or company for several months. In this street vendor report, several work implementation activities are presented, findings of obstacles or problems and proposed solutions to obstacles or problems encountered at the PT.Plasa Telkom Group Jambi Agency for 2 months, namely August 29 2022 to October 28 2022. Placement of street vendors in this agency the author is placed in the Data Management Help Desk work area in this division, ensuring that the data administration process is reliable, easily accessible, and up-to-date in terms of time. This process includes the acquisition, validation, storage and protection, monitoring and careful processing of necessary data. Based on the implementation of Field Work Practices at PT.Plasa Telkom Group Jambi, it can be concluded that the author gets an overview of the application of knowledge or theory that has been obtained in lectures, gains new experience in adapting to the world of work by communicating well and the author gains insight and knowledge about the world of work
WHY most (but perhaps not all) DMARDs work equally well
No full textCopyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.Biological- or targeted-synthetic DMARD-responses reported in randomized clinical trials, placebo-controlled or head-to-head, in patients with rheumatoid arthritis, psoriatic arthritis or spondyloarthritis are unbelievably similar, when looking across trials performed in the same disease and applying the same primary outcome measures. The exception to this rule may be the response to Janus-kinase-inhibitors, which seem to work 10 % better in all trials (JAK-bonus) This article provides a potential explanation for this remarkable phenomenon, including an explanation for the JAK-bonus. It seems as if JAK-inhibitors exert some inflammation-independent effects on pain, fatigue and wellbeing, and that drug treatment of rheumatic diseases is more than the inhibition of inflammation alone.proofpublishe
Sensitivity to change of structural outcomes in axial spondyloarthritis after 10 years of follow up. Data from the DESIR cohort
No full text© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVE: To evaluate the sensitivity to change in structural imaging outcomes over 10 years of follow-up in patients with axial spondyloarthritis (axSpA). METHODS: Patients with axSpA from the Devenir des Spondyloarthropathies Indifferénciées Récentes cohort were included. Radiographs and MRIs of the sacroiliac joints (SIJ) and spine were obtained at baseline and at 1, 2, 5 and 10 years. The yearly rate of change of each structural outcome was analysed using generalised estimating equation models, including all patients with ≥1 score from ≥1 reader from ≥1 reading wave, using the time (years) as an explanatory variable and adjusting for reader and wave. All outcomes were standardised, and the relative standardised rate of change was calculated (ie, the standardised rate of an outcome divided by the rate of a reference outcome). RESULTS: A total of 659 patients (46% males and mean age 33.6 years) were included. The most sensitive outcome to change in the SIJ (both MRI and radiographs) was the presence of ≥3 fatty lesions at a specific timepoint, with a relative standardised rate of change per year of 5.28 using the modified New York criteria as reference.Similarly, the most sensitive to change (in both MRI and radiographs) outcome in the spine was the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS; relative standardised yearly change 1.76) using ≥1 syndesmophyte as reference. CONCLUSION: MRI structural outcomes in the SIJ (ie, fatty lesions) are more sensitive to change than radiographic outcomes. Conversely, the mSASSS remains the most sensitive method, even when compared with MRI of the spine.publishersversionpublishe
should we go more distal?
No full textPublisher Copyright: © Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.OBJECTIVES: To assess the value of adding the ultradistal level to other more thoroughly studied levels of the carpal tunnel when measuring the cross-sectional area (CSA) of the median nerve (MN) by ultrasound (US) in diagnosing patients with primary carpal tunnel syndrome (CTS). METHODS: Patients clinically diagnosed with primary CTS and healthy controls were included. The MN-CSA was measured by US at three wrist levels: proximal, distal and ultradistal. The best cut-off to differentiate cases and controls was determined for the CSA and for the difference between levels of the same wrist. The performance of different definitions for US-CTS compared with the clinical diagnosis of CTS was evaluated: (1) CSA above cut-off at each level; (2) CSA-difference above cut-off at each level; (3) ≥1 level with CSA above cut-off and (4) ≥1 CSA-difference above cut-off. Definition 3, excluding the ultradistal level, and combinations of definitions were also tested. RESULTS: In total, 219 patients and 39 controls were included. The CSA was higher in patients (10.5-16.8 mm2) than controls (6.2-7.6 mm2). The difference between groups was maximal at the ultradistal level (right: 10.1 mm2; left: 8.3 mm2). The CSA cut-offs were 11 mm2, 9 mm2 and 10 mm2 at the right, and 10 mm2, 8 mm2 and 10 mm2 at the left, for the proximal, distal and ultradistal levels, respectively. Definition 3 yielded the best balance between sensitivity (98%) and specificity (95%) (right hand). Removing the ultradistal level from definition 3 decreased sensitivity to 90%, maintaining the same specificity. CONCLUSIONS: Adding the ultradistal level improves the performance of US for diagnosing CTS. We suggest adding it in clinical practice when investigating CTS.publishersversionpublishe
Associations between syndesmophytes and facet joint ankylosis in radiographic axial spondyloarthritis patients on low-dose CT over 2 years
No full text© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.OBJECTIVES: In radiographic axial spondyloarthritis (r-axSpA), spinal damage manifests as syndesmophytes and facet joint ankylosis (FJA). We evaluated whether the presence of one lesion increased the risk of the other lesion. METHODS: Patients with r-axSpA underwent low-dose CT (ldCT) and MRI of the whole spine at baseline and two years. On ldCT, vertebrae were scored for presence and size of syndesmophytes; facet joints were assessed for ankylosis. MR images were assessed for inflammation. Two hypotheses were tested: 1) presence of FJA is associated with new syndesmophyte(s) on the same vertebral unit (VU) two years later, and 2) presence of bridging syndesmophyte(s) is associated with new FJA on the same VU two years later. Two Generalized Estimating Equations models were tested per hypothesis using increase of FJA/syndesmophytes (model A) or presence of FJA/syndesmophytes (model B) as outcome, adjusted for inflammation at baseline. Secondary analyses tested the hypotheses with outcomes on adjacent VUs and dose-response effects. RESULTS: Fifty-one patients were included (mean age 49, 84% male, 82% HLA-B27+). Baseline bridging syndesmophytes occurred more often (range: 10-60% per VU) than FJA (range: 8-36%). ORs(95%CI) for presence of bridging syndesmophytes on development of FJA were 3.55(2.03-6.21) for model A and 3.30(2.14-5.09) for model B. ORs for presence of baseline FJA on new syndesmophytes were 1.87(1.20-2.92) for model A and 1.69(0.88-3.22) for model B. Secondary analyses yielded positive ORs for both hypotheses. CONCLUSIONS: Bone formation in vertebrae and in facet joints influence each other's occurrence, with the effect of syndesmophytes being larger than that of FJA.publishersversionpublishe
Inflammation in the posterior elements, in particular the facet joint and facet joint ankylosis over 2-year follow-up in radiographic axial spondyloarthritis
No full textPublisher Copyright: © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.OBJECTIVES: To assess the association of posterior element (PE) and facet joint (FJ) inflammation with subsequent new FJ ankylosis (FJA) on MRI, in patients with radiographic axial spondyloarthritis (r-axSpA). METHODS: Patients from the Sensitive Imaging in Ankylosing Spondylitis cohort, inclusion criteria r-axSpA and ≥1 radiographic spinal syndesmophyte, were studied. MRI of the full spinal was performed at baseline, 1 and 2 years. PE/FJ inflammatory lesions and FJA were assessed per vertebral unit (VU) level by three readers. With multilevel time-lagged autoregressive generalised estimated equations, the association between PE/FJ inflammation and the subsequent development of FJA was investigated, taking the reader and VU levels into account. RESULTS: Out of the 58 patients with at least 2 reader scores available, mean age 49 (SD 10) years, 84% men, 59% had baseline PE inflammation, 24% had FJ inflammation and 26% had FJA. PE inflammation was more prevalent in the lower thoracic spine and FJ inflammation in the upper thoracic spine. VU with PE or FJ inflammation showed subsequent new FJA in two and one VU levels, respectively. The probability of developing FJA doubled with prior FJ inflammation. In multilevel analysis, FJ inflammation was associated with subsequent FJA (OR=3.8, 95% CI: 1.5 to 9.8), while no association was found between PE inflammation and new FJA (OR=1.2 (0.6-2.4)). CONCLUSIONS: FJ inflammation is rare in severe r-axSpA, but when present, the likelihood of developing subsequent FJA is over three times higher compared with FJ without inflammation. This finding contributes to the understanding of the relationship between inflammation and ankylosis at the same anatomical location in patients with axSpA.publishersversionpublishe
Role of vertebral corner inflammation and fat deposition on MRI on syndesmophyte development detected on whole spine low-dose CT scan in radiographic axial spondyloarthritis
No full textPublisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.OBJECTIVES: To investigate the associations between MRI detected vertebral corner inflammation (VCI) and vertebral corner fat deposition (VCFD) on whole spine low-dose CT scan (ldCT) detected syndesmophyte formation and growth. METHODS: Patients from the Sensitive Imaging in Ankylosing Spondylitis cohort underwent MRI (baseline, 1 year and 2 years) and ldCT (baseline and 2 years). MR images were scored by three readers for VCI and VCFD, MRI patterns were defined by presence of VCI and/or VCFD over 2 years. LdCT images were scored by two central readers for presence and size of syndesmophytes and change was calculated for new or new/grown syndesmophytes. Multilevel generalised estimated equations were used to test the associations between VCI and VCFD and syndesmophyte development. RESULTS: Fifty radiographic patients with axial spondyloarthritis were included (mean age 49 years, 86% male, 78% HLA-B27+). Absence of both VCI and VCFD protected against syndesmophyte development (ORs 0.36-0.37). Presence of VCI and/or VCFD increased the risk of syndesmophyte development (ORs 1.73-2.60). Out of all corners with a new or new/grown syndesmophyte, 47% of corners according to reader 1 and 44% according to reader 2 had neither VCI nor VCFD preceding the bone formation. CONCLUSIONS: VCI and VCFD were positively associated with syndesmophyte development. This has been shown for the first time for syndesmophytes detected on ldCT and also in the thoracic spine. However, almost half of all bone formation occurred in corners without VCI or VCFD, suggesting the presence of these lesions in yearly MRIs does not fully clarify the development of syndesmophytes.publishersversionpublishe
Induction of sustained remission in early inflammatory arthritis with the combination of infliximab plus methotrexate: The DINORA trial
No full textBackground: In the present study, we explored the effects of immediate induction therapy with the anti-tumour necrosis factor (TNF)α antibody infliximab (IFX) plus methotrexate (MTX) compared with MTX alone and with placebo (PL) in patients with very early inflammatory arthritis. Methods: In an investigator-initiated, double-blind, randomised, placebo-controlled, multi-centre trial (ISRCTN21272423, http://www.isrctn.com/ISRCTN21272423 ), patients with synovitis of 12 weeks duration in at least two joints underwent 1 year of treatment with IFX in combination with MTX, MTX monotherapy, or PL randomised in a 2:2:1 ratio. The primary endpoint was clinical remission after 1 year (sustained for at least two consecutive visits 8 weeks apart) with remission defined as no swollen joints, 0-2 tender joints, and an acute-phase reactant within the normal range. Results: Ninety patients participated in the present study. At week 54 (primary endpoint), 32% of the patients in the IFX + MTX group achieved sustained remission compared with 14% on MTX alone and 0% on PL. This difference (p < 0.05 over all three groups) was statistically significant for IFX + MTX vs PL (p < 0.05), but not for IFX + MTX vs MTX (p = 0.10), nor for MTX vs PL (p = 0.31). Remission was maintained during the second year on no therapy in 75% of the IFX + MTX patients compared with 20% of the MTX-only patients. Conclusions: These results indicate that patients with early arthritis can benefit from induction therapy with anti-TNF plus MTX compared with MTX alone, suggesting that intensive treatment can alter the disease evolution. © 2018 The Author(s)
The Assessment of SpondyloArthritis International Society (ASAS) Consensus-Based Expert Definition of Difficult-to-Manage, including Treatment-Refractory, Axial Spondyloarthritis
No full textPublisher Copyright: © 2025 The Author(s)Objectives: To develop a consensus-based expert definition of difficult-to-manage (D2M) axial spondyloarthritis (axSpA), incorporating treatment-refractory (TR) disease. Methods: A literature review was conducted in 2022 to identify potential definitions for D2M/TR axSpA from prior studies, followed by a 2-round Delphi consensus process conducted in 2022 and 2023 to identify components of D2M axSpA. Based on the results of the Delphi process, a draft of the D2M axSpA definition was developed and presented to the expert task force, including patient representation, and, subsequently, to the Assessment of SpondyloArthritis International Society (ASAS) membership for endorsement in January 2024. Results: Consensus was reached on a D2M definition encapsulating treatment failure (treatment according to the ASAS-European Alliance of Associations for Rheumatology recommendations and failure of ≥2 biological or targeted synthetic disease-modifying antirheumatic drugs with different mechanisms of action unless contraindicated), suboptimal disease control, and physician or patient acknowledgement of problematic signs/symptoms in patients diagnosed with axSpA by the rheumatologist. This definition represents a broad concept that includes various reasons that lead to an unsatisfactory treatment outcome. TR axSpA is covered by the D2M definition but requires a history of treatment failure, the presence of objective signs of inflammatory activity, and the exclusion of noninflammatory reasons for nonresponse. The proposed D2M definition incorporating TR disease was endorsed by ASAS at the annual meeting in January 2024, with 89% votes (109/123) in favour of it. Conclusions: The ASAS D2M axSpA definition, including TR disease, allows for identifying patients with unmet needs, paving the way for further research in this condition and its clinical care improvement.publishersversionpublishe
