1,720,961 research outputs found
Dose reduction of biological therapies for inflammatory rheumatic diseases: what do patients think?
No full textBiologic dose reduction in rheumatoid arthritis: what do patients think? Results from a patient and public involvement event
No full textAbstract: Background: Biological therapies are well established and effective treatments for rheumatoid arthritis (RA). Although it seems impossible to stop biological therapies for the majority of RA patients with established disease it appears that dose reduction can be successful in some patients in remission or with low disease activity. Stratified medicine approaches may identify individuals who are most likely to maintain low levels of disease activity on a reduced biological therapy dose while achieving the same clinical benefit. Dose reduction may allow a reduced risk of adverse events and also produce economic benefits that may allow greater numbers of patients to use biological therapies. Despite an increased interest in biological therapy dose reduction in recent years, the perspectives of patients have not yet been reported. Engagement of patients in shared decision-making about their disease management is vital to improving health outcomes and a stated aim of many treatment guidelines. We aimed to investigate the views of patients with regard to biological therapies and dose reduction.Methods: We arranged a patient and public involvement (PPI) event with 9 patients (8 female, mean age 49y, mean disease duration 17y) with RA. Eight patients were on a biological therapy with 2 patients on a reduced dose. Discussion was facilitated and recorded by two PPI experts and a consultant rheumatologist. Participants (1) discussed biological therapy in general, (2) listed the top 10 concerns about biological therapy and (3) explored attitudes towards dose reduction.Results: The most common issues arising during group discussion about biological therapies in general were: impact of disease on health, delays in accessing treatment, need for education about biological therapies, adverse effects, inefficacy of previous treatments, impact of disease on family and work and patient autonomy. When exploring attitudes towards dose reduction, the most common concerns were loss of disease control, delay in access to the previous dose and potential loss of efficacy of a previously successful treatment. Perceived benefits were a lower risk of adverse effects and reduced frequency of injection.Conclusion: Patients were generally prepared to consider dose reduction but need reassurance about rapid access to higher doses should their disease flare. The data provide insight into patients’ beliefs and attitudes towards biological therapies and dose reduction and will be used to generate a questionnaire to be distributed to a larger group of patients
An unusual case of cutaneous tuberculosis and paradoxical TB in a patient with spondyloarthritis treated with adalimumab
No full textCutaneous tuberculosis (TB) is an uncommon condition, the diagnosis of which can be challenging. Biologic disease-modifying anti-rheumatic drugs (bDMARDs) are associated with a higher risk of opportunistic infections, including TB. We present a case of cutaneous TB in a 56-year-old male with psoriatic arthritis on adalimumab. He developed skin lesions on his thumb and axilla, and Mycobacterium tuberculosis was isolated in cultures sent from a skin biopsy. Four months after commencement of TB treatment, he presented with a new onset of seizures. An MRI head showed two tuberculomas, with no further lesions identified in cross-sectional imaging. A tapering course of steroids was started alongside a 12-month course of anti-TB treatment for post-tuberculous treatment paradoxical reaction. In conclusion, although uncommon, cutaneous TB should be considered in patients on bDMARD treatment with atypical skin lesions
Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation?
No full textBackground: Axial spondyloarthritis (axSpA) frequently presents during working age and therefore impacts work participation. Biologic therapies have demonstrated a positive impact on work-related outcomes in clinical trials but real world data are limited. Therefore, we investigated the prevalence and predictors of work impairment and disability among axSpA patients attending a biologic therapy clinic.Methods: This was a single-centre, cross-sectional study of patients with axSpA treated with biologic therapy. Work participation was assessed with the Work Productivity and Activity Impairment (WPAI) Questionnaire. Work outcomes (presenteeism, absenteeism, health-related job loss) were compared for gender, time since diagnosis, smoking status and disease outcome measures.Results: Data were available for 165 patients (mean age 47.6 years, 75% male, 21% current smokers). Mean time since diagnosis was 15.5 years and mean duration of biologic therapy 4.7 years; 19/165 (11.5%) were on a tapered-dose regimen. Occupational data were available for 144 patients amongst whom 101 (70.1%) were either currently employed or in full time education. Of those eligible to work, 17/118 (14.4%) reported inability to work due to their axSpA. Amongst those in employment, 10.8% reported absenteeism due to axSpA in the week prior to their clinic visit (mean hours missed = 13). The mean work productivity impairment was 23%. Higher disease activity (BASDAI) and markers of global health, quality of life and pain, (BAS-G, ASQoL and spinal pain VAS) were associated with axSpA related job loss, absenteeism and presenteeism.Conclusions: In this group of axSpA patients on biologic therapy (mean age 47.6 years), almost 1 in 6 (14.4%) reported axSpA related job loss. Poor work outcomes: axSpA-related work disability, absenteeism and presenteeism were associated with poorer scores for patient-reported disease outcome measures. Strategies for enhancing work productivity should be directed towards those patients at risk of poor work outcomes. More data are needed including details of the types of work that are most difficult with axSpA
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
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