The purpose of this study is to examine the moderating role of state work pressure (conceived as a hindrance demand) on the relationships between situational emotional demands (conceived as a ...challenge demand) and tension, emotional exhaustion and work engagement within nursing while considering job resources as covariates. Ninety-seven nurses from two German hospitals provided 1026 measurements. Multilevel analyses indicated a significant Work Pressure × Emotional Demands interaction for emotional exhaustion, with high situational work pressure exacerbating the positive association between state emotional demands and emotional exhaustion. Furthermore, work pressure moderated the relationship between emotional demands and vigour: state emotional demands related negatively to vigour only when work pressure was higher than usual, while the relationship was non-significant when work pressure was lower than usual. For dedication, similar results were obtained: state emotional demands were negatively associated with dedication only when combined with high situational work pressure; with low situational work pressure, state emotional demands did not relate to dedication. Contributing to the job demands-resources literature, this study shows that there are stress-exacerbating and stress-buffering interactions between different job demands from a within-subject perspective. However, we did not find positive relationships between challenge demands and work engagement, even in the case of low situational hindrances, indicating that there are conditions for the functioning of job demands as a challenge beyond hindrances.
Nail psoriasis is a chronic, difficult-to-treat condition affecting almost half of patients with psoriasis. It is associated with considerable social stigma and impairment of patients’ quality of ...life. The aim of this study was to assess improvements in objective measures of nail psoriasis among patients from the long-term extension of the UNCOVER-3 study who received the interleukin-17A inhibitor ixekizumab and had either any degree of nail psoriasis (Nail Psoriasis Severity Index (NAPSI) >=1) or significant nail psoriasis (fingernail NAPSI ≥ 16 and ≥ 4 fingernails involved) at baseline. Efficacy outcomes reported through week 264 included the mean percentage improvements from baseline in NAPSI score and the proportion of patients achieving nail psoriasis resolution (NAPSI=0). In UNCOVER-3, 56.9% (219/385) of patients had nail psoriasis at baseline; of those, 61.2% (134/219) had significant nail psoriasis. At week 60, a total of 66.9% and 59.1% of patients with baseline nail psoriasis and significant baseline nail psoriasis, respectively, reported complete clearance of nail psoriasis, an effect which was sustained through week 264. This analysis demonstrates that continuous treatment with ixekizumab in adult patients with moderate-to-severe-psoriasis through 264 weeks was associated with improvements and clearance of fingernail psoriasis, irrespective of the severity of nail psoriasis at baseline.
Factors beyond the Psoriasis Area and Severity Index (PASI) contribute to disease severity in psoriasis and potentially affect treatment responses.
This subset analysis of data from two phase 3 ...clinical studies assessed baseline parameters in patients with different degrees of psoriasis severity in order to determine treatment responses to ixekizumab and safety outcomes.
This study used integrated data from the UNCOVER-2 and -3 trials involving 2709 patients with chronic plaque psoriasis to assess the efficacy and safety of ixekizumab in three subgroups of patients, defined by PASI > 15 (group 1), PASI > 15 and history of ≥3 non-biologic systemic therapies (group 2), or PASI = 12-15 (group 3).
In groups 1 and 2, additional baseline features were identified that could influence treatment responses, including age at disease onset, Dermatology Life Quality Index, and work productivity. Irrespective of subgroup, ixekizumab demonstrated high PASI responses at weeks 12 and 60, which were evident as early as week 2. Adverse events did not differ across subgroups.
Our data support the efficacy, early onset of action, and maintained response of ixekizumab as observed in previous trials, and highlight the complexity of comprehensively defining disease severity in psoriasis.
Background: Diagnostic algorithms may reduce noise and bias and improve interrater agreement of clinical decisions. In a practical sense, algorithms may serve as alternatives to specialist ...consultations or decision support in store-and-forward teledermatology. It is, however, unknown how dermatologists interact with algorithms based on questionnaires.
Objective: To evaluate the performance of a questionnaire-based diagnostic algorithm when applied by users with different expertise.
Methods: We created 58 virtual test cases covering common dermatologic diseases and asked five raters with different expertise to complete a predefined clinical questionnaire, which served as input for a disease ranking algorithm. We compared the ranks of the correct diagnosis between users, analysed the similarity between inputs of different users, and explored the impact of different parts of the questionnaire on the final ranking.
Results: When applied by a board-certified dermatologist, the algorithm top-ranked the correct diagnosis in the majority of cases (median rank 1; IQR: 1.0; mean reciprocal rank 0.757). The median rank of the correct diagnosis was significantly lower when the algorithm was applied by four dermatology residents (median rank 2-5, p<.01 for all). The lowest similarity between inputs of the residents and the board-certified dermatologist was found for questions regarding morphology. Sensitivity analysis showed the highest deterioration in performance after omission of information on morphology and anatomic site.
Conclusions: A simple questionnaire-based disease ranking algorithm provides accurate ranking for a wide variety of dermatologic conditions. When applied in clinical practice, additional measures may be needed to ensure robustness of data entry for inexperienced users.
The Revised Illness Perception Questionnaire (IPQ-R) has been shown to assess illness perception reproducibly in primary cutaneous T-cell lymphomas (CTCL). Illness perception reflects patients' ...individual concepts of understanding and interpretation of the disease, influencing illness behaviour and health-related quality of life (HRQOL). This study investigated the clinical relevance of the relationships between illness perception, illness behaviour, and HRQOL in CTCL and cutaneous B-cell lymphomas (CBCL). A total of 92 patients completed the IPQ-R, the Scale for the Assessment of Illness Behavior (SAIB), and a skin-specific HRQOL tool (Skindex-29). Data on illness behaviour were not evidently related to illness perception, whereas illness perception was significantly associated with HRQOL. Both, IPQ-R and HRQOL results correlated with disease entity, stage, and socio-demographics. Only IPQ-R results provided practical information on patients' needs to train personal coping strategies. IPQ-R assessment in CTCL and CBCL might be a useful instrument to improve individual disease management.
Dermatoscopy of pigmented Bowen's disease Cameron, Alan, MBBS; Rosendahl, Cliff, MBBS; Tschandl, Philipp, CandMed ...
Journal of the American Academy of Dermatology,
04/2010, Letnik:
62, Številka:
4
Journal Article
Recenzirano
Background Pigmented Bowen's disease is not well characterized. Objective To characterize the clinical and dermatoscopic appearance of pigmented Bowen's disease. Methods We performed a retrospective ...analysis of 52 consecutive cases of pigmented Bowen's disease. Results Of 951 histopathologically verified cases of Bowen's disease that underwent biopsy during the study period, 52 (5.5%) were pigmented. Dermatoscopically pigmented Bowen's disease is typified by a pattern of dots and/or structureless zones. In 21.2% (n = 11), we observed brown or gray dots arranged in a linear fashion. Vessels were identified in 67.3% of lesions with a predomination of coiled vessels. A linear arrangement of vessels was seen in 11.5%. Limitations Conclusions are limited by the fact that this was a retrospective, uncontrolled study. Conclusions Pigmented Bowen's disease has a characteristic dermatoscopic pattern. Linear arrangement of brown and/or gray dots and/or coiled vessels is a specific clue to pigmented Bowen's disease.
Baricitinib is an oral selective Janus kinase 1/2 inhibitor approved for moderate-to-severe atopic dermatitis (AD) in adults.
To evaluate absolute Eczema Area and Severity Index (EASI) and SCORing of ...Atopic Dermatitis (SCORAD) outcomes over 16 weeks and to link disease severity categories to quality of life (QoL) improvements.
This post-hoc analysis included patients enrolled in Phase3 monotherapy (BREEZE-AD1/AD2) and topical corticosteroid (TCS) combination therapy (BREEZE-AD7) trials and analyzed baricitinib 2 and 4 mg vs. placebo. Categorical outcomes were analyzed using Fisher's exact test.
Significantly more baricitinib-treated patients reached EASI ≤ 7 and SCORAD < 25 as early as week 1 in monotherapy and week 2 in TCS combination therapy, compared to placebo. Significant response vs. placebo was sustained until week 16 for EASI ≤ 7 (AD1/2 p-value vs. placebo: 2 mg = 19.9%, 4 mg = 25.4% p = 0.001 and AD7: 2 mg = 40.4% p = 0.087, 4 mg = 48.6% p = 0.003) and SCORAD < 25 (AD1/2: 2 mg = 12.2%, 4 mg = 19.4% p = 0.001 and AD7: 2 mg = 30.3% p = 0.025, 4 mg = 34.2% p = 0.004) severity categories. These effects were accompanied by rapid improvements in QoL.
Baricitinib-treated patients rapidly achieved recommended absolute EASI and SCORAD treatment outcomes which were sustained until week 16. Improvements in QoL were greater than EASI severity categories reflected, indicating that physician-assessed scores do not necessarily correlate with patients' impression of AD severity.
In clinical practice, interruption of treatment may not result in immediate cessation of disease control, and some patients even experience sustained treatment response following treatment ...interruption. This post hoc analysis of UNCOVER-1 and -2 Phase 3 clinical trials characterized the time to loss of treatment response in patients with psoriasis who responded to ixekizumab through a 12-week treatment period, and who were then re-randomized to placebo for the following 48 weeks. For those with static Physician Global Assessment sPGA0/1 and Psoriasis Area and Severity Index PASI90 at Week 12, the median time to loss of PASI90 was 16.1 weeks (95% confidence interval 12.7-16.4). For those with PASI100 at Week 12, the median time to loss of PASI100 was 12.1 weeks (95% confidence interval 9.0-13.0). A small subset of patients maintained high levels of disease control through Week 60. This study adds to the growing body of evidence on sustained treatment response following treatment interruption.
Psoriasis localized at the scalp, face, nails, genitalia, palms, and soles can exacerbate the disease burden. Real-world studies comparing the effectiveness of treatments for these special areas are ...limited.
Psoriasis Study of Health Outcomes (PSoHO) is an international, prospective, non-interventional, study comparing the effectiveness of anti-interleukin (IL)-17A biologics (ixekizumab and secukinumab) compared to other approved biologics and the pairwise comparative effectiveness of ixekizumab relative to five other individual biologics for patients with moderate-to-severe psoriasis. To determine special area involvement, physicians answered binary questions at baseline and week 12. The proportion of patients who achieved special area clearance at week 12 was assessed. Missing outcome data were imputed as non-response. Comparative treatment analyses were conducted using frequentist model averaging.
Of the 1,978 patients included, 83.4% had at least one special area involved at baseline with the scalp (66.7%) as the most frequently affected part, followed by nails (37.9%), face/neck (36.9%), genitalia (25.6%), and palms and/or soles (22.2%). Patients with scalp, nail, or genital, but not palmoplantar or face/neck psoriasis, had significantly higher odds of achieving clearance at week 12 in the anti-IL-17A cohort compared to the other biologics cohort. Patients with scalp psoriasis had a 10-20% higher response rate and significantly greater odds (1.8-2.3) of achieving clearance at week 12 with ixekizumab compared to included biologics.
Biologics demonstrate a high level of clearance of special areas at week 12 in a real-world setting. Patients with scalp, nail, or genital involvement have significantly higher odds of clearance at week 12 with anti-IL-17A biologics compared to other biologics.
PDF
