Objective
To assess the determinants of patients' (PTGL) and physicians' (MDGL) global assessment of rheumatoid arthritis (RA) activity and factors associated with discordance among them.
Methods
A ...total of 7,028 patients in the Quantitative Standard Monitoring of Patients with RA study had PTGL and MDGL assessed at the same clinic visit on a 0–10‐cm visual analog scale (VAS). Three patient groups were defined: concordant rating group (PTGL and MDGL within ±2 cm), higher patient rating group (PTGL exceeding MDGL by >2 cm), and lower patient rating group (PTGL less than MDGL by >2 cm). Multivariable regression analysis was used to identify determinants of PTGL and MDGL and their discordance.
Results
The mean ± SD VAS scores for PTGL and MDGL were 4.01 ± 2.70 and 2.91 ± 2.37, respectively. Pain was overwhelmingly the single most important determinant of PTGL, followed by fatigue. In contrast, MDGL was most influenced by swollen joint count (SJC), followed by erythrocyte sedimentation rate (ESR) and tender joint count (TJC). A total of 4,454 (63.4%), 2,106 (30%), and 468 (6.6%) patients were in the concordant, higher, and lower patient rating groups, respectively. Odds of higher patient rating increased with higher pain, fatigue, psychological distress, age, and morning stiffness, and decreased with higher SJC, TJC, and ESR. Lower patient rating odds increased with higher SJC, TJC, and ESR, and decreased with lower fatigue levels.
Conclusion
Nearly 36% of patients had discordance in RA activity assessment from their physicians. Sensitivity to the “disease experience” of patients, particularly pain and fatigue, is warranted for effective care of RA.
Background Predictions suggest Africa’s combined Gross Domestic Product (GDP) will be amongst the fastest growing on earth in the next two decades. An expectation is that the majority of African ...homes will enter the consumer class, and educational performance will improve significantly within the next two decades. Nonetheless, organisations competing in Africa face numerous challenges. These include its size and complexity, transformational population growth, an abundance of talent but a lack of skills, a scarcity of large companies, the relatively small size of big companies, a poorly understood business environment, conflict, poverty and corruption. To successfully address these challenges, entrepreneurial energy and a strategy to develop leadership skills at scale is required.Aim The purpose of this study was to develop and assess whether a leadership skills development model which integrates six conceptual constructs is valid as a model for developing leadership skills in African fast-moving consumer goods (FMCG) business-networks.Method The study took a pragmatic approach and followed an explanatory sequential design typology. An initial quantitative stage was conducted. Using inductive thematic interpretation methodology, the qualitative results helped explain the initial quantitative results. Applying confirmatory factor analysis, three data-model fit tests gave empirical evidence that the leadership skills development model was a good model fit.Findings The outcomes and practical value of this study included a theoretically relevant, empirically validated leadership skills development model, Super-Cube® for African FMCG (Fast Moving Consumer Goods) business-networks, as well as a range of recommendations on how to develop leadership skills throughout Africa.Conclusion Leadership skills development is complex, especially in a rapidly changing environment. This study is the first that proposes a leadership skills development model for African FMCG business-networks that directly contributes to the discipline of leadership and leadership development.
In the early summer of 1930, Peter Elkin, a prominent figure in early Australian anthropology, travelled to the Mount Margaret Mission, near Laverton in the northern Goldfields region of Western ...Australia. He did so to follow up research begun on the eastern edge of the Nullarbor Plain, with Aboriginal groups who comprised what was later dubbed the Western Desert Cultural Bloc, a common cultural region covering the vast arid zone of central Australia. Elkin conducted fieldwork at Mount Margaret for three weeks, met only some of the Aboriginal people there and never returned, but in an article published subsequently he made a significant extrapolation. The Aboriginal people at Mount Margaret did not belong there. They had come in from the Warburton Range and the border country and replaced the local groups which had, as Elkin phrased it, 'almost ceased to exist'.
Objective
Because musculoskeletal ultrasound (MSUS) is highly user dependent, we aimed to establish whether non‐mentored learning of MSUS is sufficient to achieve the same level of diagnostic ...accuracy and scanning reliability as has been achieved by rheumatologists recognized as international experts in MSUS.
Methods
A group of 8 rheumatologists with more experience in MSUS and 8 rheumatologists with less experience in MSUS participated in an MSUS exercise to assess patients with musculoskeletal abnormalities commonly seen in a rheumatology practice. Patients' established diagnoses were obtained from chart review (gout, osteoarthritis, rotator cuff syndrome, rheumatoid arthritis, and seronegative arthritis). Two examining groups were formed, each composed of 4 less experienced and 4 more experienced examiners. Each group scanned 1 predefined body region (hand, wrist, elbow, shoulder, knee, or ankle) in each of 8 patients, blinded to medical history and physical examination. Structural abnormalities were noted with dichotomous answers, and an open‐ended answer was used for the final diagnosis.
Results
Less experienced and more experienced examiners achieved the same diagnostic accuracy (US‐established diagnosis versus chart review diagnosis). The interrater reliability for tissue pathology was slightly higher for more experienced versus less experienced examiners (κ = 0.43 versus κ = 0.34; P = 0.001).
Conclusion
Non‐mentored training in MSUS can lead to the achievement of diagnostic accuracy in MSUS comparable to that achieved by highly experienced international experts. Reliability may increase slightly with additional experience. Further study is needed to determine the minimal training requirement to achieve proficiency in MSUS.
Here we report the development of an in vivo system to study the interaction of stem cells with drugs using a tumor model in the adult Drosophila intestine. Strikingly, we find that some Food and ...Drug Administration-approved chemotherapeutics that can inhibit the growth of Drosophila tumor stem cells can paradoxically promote the hyperproliferation of their wild-type counterparts. These results reveal an unanticipated side effect on stem cells that may contribute to tumor recurrence. We propose that the same side effect may occur in humans based on our finding that it is driven in Drosophila by the evolutionarily conserved Janus kinase-signal transducers and activators of transcription (JAK-STAT) pathway. An immediate implication of our findings is that supplementing traditional chemotherapeutics with anti-inflammatories may reduce tumor recurrence.
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