Objective
To provide evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
Methods
A core group led the ...development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework.
Results
In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS.
Conclusion
These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.
Nonselective non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 inhibitors (COX-2s) are used to treat a variety of arthritic and inflammatory conditions. The aim of this study was to ...assess the upper gastrointestinal (GI) harms of the long-term use of COX-2s, compared with nonselective NSAIDs and placebo, in arthritis sufferers.
A systematic review of randomized controlled trials (RCTs) was conducted. Searches were conducted in (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) the Cochrane Collaboration Library (2005), (3) MEDLINE (to December 2006), and (4) Excerpta Medica Database (EMBASE) (to June 2005). Reference lists from trials and abstracts of conference proceedings were searched by hand, and experts were contacted to identify further relevant trials. RCTs of celecoxib, rofecoxib, etoricoxib, valdecoxib, and lumiracoxib were included if they reported on endoscopic ulcers, clinically important ulcer complications, or adverse gastrointestinal (GI) symptoms with the use of these COX-2s, compared with placebo or with nonselective NSAIDs. Study selection and data extraction were performed in duplicate by independent reviewers. Data were analyzed by using Review Manager 4.2 in accordance with accepted meta-analysis techniques.
Compared with nonselective NSAIDs, COX-2s produced significantly fewer gastroduodenal ulcers (relative risk, 0.26; 95% confidence interval, 0.23-0.30) and clinically important ulcer complications (relative risk, 0.39; 95% confidence interval, 0.31-0.50), as well as fewer treatment withdrawals caused by GI symptoms. The co-administration of acetylsalicylic acid appears to reduce the GI safety of COX-2s in subgroup analyses.
COX-2s appear to offer greater upper GI safety and are better tolerated than nonselective NSAIDs. The co-administration of acetylsalicylic acid might reduce the safety advantage of COX-2s over that of nonselective NSAIDs.
Objective
To provide evidence‐based recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA).
Methods
A core group led the ...development of the recommendations, starting with the treatment questions. A literature review group conducted systematic literature reviews of studies that addressed 57 specific treatment questions, based on searches conducted in OVID Medline (1946–2014), PubMed (1966–2014), and the Cochrane Library. We assessed the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method. A separate voting group reviewed the evidence and voted on recommendations for each question using the GRADE framework.
Results
In patients with active AS, the strong recommendations included use of nonsteroidal antiinflammatory drugs (NSAIDs), use of tumor necrosis factor inhibitors (TNFi) when activity persists despite NSAID treatment, not to use systemic glucocorticoids, use of physical therapy, and use of hip arthroplasty for patients with advanced hip arthritis. Among the conditional recommendations was that no particular TNFi was preferred except in patients with concomitant inflammatory bowel disease or recurrent iritis, in whom TNFi monoclonal antibodies should be used. In patients with active nonradiographic axial SpA despite treatment with NSAIDs, we conditionally recommend treatment with TNFi. Other recommendations for patients with nonradiographic axial SpA were based on indirect evidence and were the same as for patients with AS.
Conclusion
These recommendations provide guidance for the management of common clinical questions in AS and nonradiographic axial SpA. Additional research on optimal medication management over time, disease monitoring, and preventive care is needed to help establish best practices in these areas.
The authors evaluated whether self-hypnotic relaxation can reduce the need for intravenous conscious sedation during interventional radiological procedures. Sixteen patients were randomized to a test ...group, and 14 patients were randomized to a control group. All had patient-controlled analgesia. Test patients additionally had self-hypnotic relaxation and underwent a Hypnotic Induction Profile test. Compared to controls, test patients used less drugs (0.28 vs. 2.01 drug units; p < .01) and reported less pain (median pain rating 2 vs. 5 on a 0-10 scale; p < .01). Significantly more control patients exhibited oxygen desaturation and/or needed interruptions of their procedures for hemodynamic instability. Benefit did not correlate with hypnotizability. Self-hypnotic relaxation can reduce drug use and improve procedural safety.
As Scotland begins a new era in its history after 300 years of being governed from Westminster, many contradictory effects on the cultural, historical, literary and economic life of the country have ...begun to be put into perspective. The focus of this thesis is the dystopic impulses in some key texts of contemporary urban Scottish literature since Alasdair Gray's Lanark was published in 1981. It argues that the defining moment in recent Scottish political and literary history was the failed 1979 Devolution Referendum and the devastating effects of eighteen years of Tory leadership on Scotland. Five chapters focus on works of urban fiction, mostly set in Glasgow and the West of Scotland: Alasdair Gray's 1982 Janine, James Kelman's How Late It Was, How Late, Janice Galloway's The Trick Is To Keep Breathing, Irvine Welsh's Trainspotting and A.L. Kennedy's So I Am Glad. Chapter Seven comprises a review of more recent work to illustrate the continuing vibrancy and diversity of contemporary Scottish fiction and to help put the literary and political history into a contemporary context. The main theme of this thesis is addiction, central to much of the content of these novels: to alcohol, drugs, sex, anorexia nervosa and bulimia. The principal argument of each novel suggests the incompatibility of the ideologies of the capitalist and imperialist systems with self-determination, social justice and questions of class and language. Patriarchy and the role of institutions are observed as repressive instruments of government and the embedded attitudes of state and family display a culture that exhibits many of the symptoms of the individual addict. The effects of the widening poverty gap as a result of the "Thatcher Revolution" in Scotland are examined through the disrupted lives of the novels' protagonists; the effects of church and state on the lack of community are also considered. Cross generational family dysfunction or absence of family is also evident in all the narratives depicting a culture of dependency and blame and a preponderance of sexual immaturity. Scotland as a nation is portrayed as a victimized society with a history of an absence of entitlement, with respect not only to women, but also to men. Violent behavior is commonplace and condoned; the "hard man" is not purely a sensationalist fictional character. The impact of Scotland as a stateless nation is cumulative and has resulted in a certain social paralysis (denial) and hopelessness (hangover), leading to varying responses for three of the male protagonists in the novels of Gray, Welsh and Kelman: from escape to attempted suicide. All but one of the novels uses first-person, interior monologue as a device to draw the reader into a more sympathetic understanding of the protagonists' pain and trauma, in what are, generally disturbing and depressing narratives. The use of experimental literary devices and different literary genres is a hallmark of all the novels, from the mixing of realism and fantasy to the pared-down existential narrative illustrating the dysfunction and fragmentation of the protagonists. The voices of all but one clearly define the protagonists as coming from a working-class background. The fictional characters are all wrestling with their own demons in an effort to make some sense out of their lives, but humor is the saving grace of most, lifting the reader out of depths of despair that these stories might have engendered. There is, however a divide in the emotional and political perspective of the last two and most recent novels, enabling the protagonists to walk away from their dependent selves and serving notice to the repressive effects of church and state. Women, however, are portrayed as symbolic creatures of an abused nation, near parodies of sexual stereotyping or off in the margins and footnotes in the three novels written by men. The two female novelists treat their subjects differently. While the content of the novels is no less despairing the female protagonists argue compellingly that madness might well be a viable alternative to their present situation. Evident in both are intimate observations on the themes of sudden death, family dysfunction, oppression, suppression and loneliness, leading one protagonist to display violent and abusive sexual behavior and the other to be on the verge of a mental breakdown. However, these two novels by women also point more positively toward recovery, as if coming out a period of intense therapy. While all the novels portray a demonic view of Scottish life, there is honesty to the narratives, which helps to give them a distinctive voice and place internationally. If literature as protest is allied with political action in representing the need for Scotland to come to terms with itself and its history, these novels help take the first steps toward recovery and self-determination.
This study was designed to analyze characteristics of those elementary beginning teachers who were evaluated as successful by their building level administrators. An attempt was made to determine ...relationships between undergraduate course work, field experiences and classroom success. Personality characteristics were also analyzed to determine commonalities or indicators of classroom success among personality types. The domains identified on The Florida Performance Management System (FPMS) were used as the competencies upon which building level administrators evaluated the beginning teachers. Three data gathering instruments were used to acquire information about the beginning teachers participating in the study. Statistical analysis of the data gathered included ANOVA and T-Test procedures. The findings indicated that there was no significance for the type and number of undergraduate courses in relation to perceived beginning teachers' success. Number of student teaching situations, or internships, nor geographical settings had any significant effect on beginning teachers' perceived success. Personality types were found to be very diverse, but did not significantly effect beginning teachers' perceived success. Strengths and weaknesses in competencies for beginning teachers were identified by both the beginning teachers and their building level administrators. The study concluded that beginning teachers' perceived classroom success is not affected by type or number of undergraduate courses, types or length of field experiences or personality factors. Further research needs to be conducted, on a broader scale, with a larger sample, or with different variables to identify what contributes to success in the classroom. Additionally, strategies must be in place, at the individual school site, to assist beginning teachers as they start their teaching career.
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