Drug survival of fumaric acid esters for psoriasis: a retrospective study

BACKGROUND

Fumaric acid esters (FAEs) have been used for over 30 years in the management of psoriasis.

OBJECTIVES

To determine drug survival of FAEs in patients with psoriasis, treatment-limiting adverse drug events and the range of effective drug doses.

METHODS

A retrospective, single-centre study assessing all patients commenced on FAEs between October 2003 and July 2012. Demographic data, length of treatment, reasons for discontinuation of FAEs, side-effects and range of doses were recorded.

RESULTS

Two hundred and forty-nine patients [160 (64%) male] were included. The mean age at which FAEs were commenced was 44·5 years (range 17-82 years). The mean length of treatment was 28 months (range 1 week to 106 months). In patients who were commenced on FAEs ≥ 4 years before inclusion in this study, the 4-year drug survival was 60% (64/107). FAEs were discontinued in 146/249 patients (59%); this was due to lack of efficacy in 59/146 (40%) and gastrointestinal upset in 39/146 (27%). A very low dose of FAEs (< 240 mg daily) was successful in maintaining control of psoriasis in 26 (10%) patients. The mean treatment duration of these patients was 64 months (range 32-106 months).

CONCLUSIONS

Fumaric acid esters have a 4-year drug survival rate of 60%, which compares favourably with reported 4-year survival rates of 40% for etanercept and adalimumab and 70% for infliximab. Longer drug survival is more likely in the significant subgroup of patients in whom a very low dose of FAEs is sufficient to control disease. The reasons for this are unclear.

Perspectives and attitudes of young patients with inflammatory bowel disease: symptoms, burden of disease and communication with their healthcare professionals

INTRODUCTION

Inflammatory bowel disease (IBD) affects a significant proportion of young patients in the UK. The role of the healthcare professional, and their relationship with the young patient is particularly important at this difficult stage of their life, when education, social integration and career planning, can be dramatically affected by this consuming condition.

OBJECTIVES

To address the attitudes, experiences and erspectives of young patients suffering from IBD, focusing particularly on the relationship between sufferer and healthcare provider.

METHODS

Crohn's and Colitis UK invited its young members to respond to a detailed internet based questionnaire addressing various aspects of patients' disease and their relationship with respective healthcare workers.

RESULTS

1081 patients aged 29 years or less responded. Self reported burden of illness was high with only 12% respondents free from a disease flare in the previous 12 months with almost half being hospitalised in the same period. Quality of ommunication with healthcare providers was generally high, with three-quarters of patients feeling appropriately empowered in their healthcare decisions. The IBD nurse specialist was highlighted as a particularly valuable member of the team, scoring the highest of the professional groups in communication comfort scores, as well as being nominated by the patients as the preferred professional group to discuss their disease with.

CONCLUSIONS

The results emphasize the considerable impact of the disease that this group is encumbered with, and identifies areas in the patient-professional relationship that can be augmented to improve the overall healthcare of this complex and fragile subgroup of patients.

Inflammatory bowel disease and exercise: results of a Crohn's and Colitis UK survey

BACKGROUND

Over 250 000 people in the UK are affected with inflammatory bowel disease (IBD) and approximately 10 000 new cases are diagnosed every year. These chronic bowel conditions have been shown to affect both work and recreational activity. In the general population, regular exercise has numerous benefits to health and well-being and there are additional benefits for those with IBD. However, people with IBD face significant challenges in trying to take regular exercise.

OBJECTIVE

With the renewed focus on sport brought about by the recent London Olympics, Crohn's and Colitis UK surveyed its members to explore their sport and fitness habits.

METHODS

918 members participated in the survey, which is the largest survey of its kind, investigating the exercise habits of people with IBD.

RESULTS

The survey showed widespread uptake of exercise in those with IBD, with a large number feeling better for it. However, it also identified a considerable number of respondents who reported a significant negative impact of IBD on their ability to take up, enjoy and derive benefit from sporting activities.

CONCLUSION

Asking questions about sporting leisure activity in clinical consultations may identify those in need of help and support and possibly identify factors to be dealt with, in order to enable them to take part in these beneficial activities.

Depth-resolved grazing-incidence time-of-flight neutron scattering from a solid–liquid interface

Small-angle scattering in grazing-incidence beam geometry has been applied on a time-of-flight neutron instrument to investigate a solid–liquid boundary. Owing to the broad wavelength distribution provided for a specific incident beam angle, the penetration depth of the neutron beam is varied over a wide range in a single measurement. The near surface structures of block copolymer micelles close to silicon substrates with distinct surface energies are resolved. It is observed that the very near surface structure strongly depends on the surface coating, whereas further away from the surface, bulk-like ordering is found.

How to help children with neurodevelopmental and visual problems: a scoping review

Children with visual impairment and a condition affecting their neurodevelopment (children with VND) may require extensive and specialised help but evidence on the most effective strategies for visual improvement is lacking. We defined a PICO format (Population, Intervention, Comparator, Outcome) for a scoping review and systematically searched 13 databases. Two reviewers assessed the abstracts for inclusion and a third arbitrated in cases of disagreement. We abstracted data from included studies. We found 4450 abstracts from which we identified 107 papers for inclusion. Of these, 42 related to interventions involving a change in visual input or function: 5 controlled trials, 8 before and after studies and 29 case reports. The strongest evidence supported the provision of spectacles to improve distance or near vision and the use of ultraviolet light as environmental modification for training. Less strong but suggestive evidence supported training/practice routines to improve acuity or oculomotor control. Interventions exist to help children with VND and current recommendations that they are assessed by a vision specialist are supported by the evidence. More information is needed on the effectiveness of training/practice programmes which may promote improved function, and of environmental modifications to facilitate engagement of children with VND with the surroundings.

Double-bundle medial patellofemoral ligament reconstruction with hamstring tendon autograft and mediolateral patellar tunnel fixation: a meta-analysis of outcomes and complications

Medial patellofemoral ligament (MPFL) reconstruction is used to treat patellar instability and recurrent patellar dislocation. Anatomical studies have found the MPFL to be a double-bundle structure. We carried out a meta-analysis of studies reporting outcomes of patellofemoral reconstruction using hamstring tendon autograft in a double-bundle configuration and patellar fixation via mediolateral patellar tunnels. A literature search was undertaken with no language restriction in various databases from their year of inception to July 2012. The primary outcome examined was the post-operative Kujala score. We identified 320 MPFL reconstructions in nine relevant articles. The combined mean post-operative Kujala score was 92.02 (standard error (se) 1.4, p = 0.001) using a fixed effects model and 89.45 (se 37.9, p = 0.02) using random effect modelling. The reported rate of complications with MPFL reconstruction was 12.5% (40 of 320) with stiffness of the knee being the most common. High-quality evidence in assessing double-bundle MPFL reconstruction is lacking. The current literature consists of a mixture of prospective and retrospective case series. High-quality randomised trials evaluating this procedure are still awaited.

Control of Rheological Behaviour with Oppositely Charged Polyelectrolyte Surfactant Mixtures

Mixtures of the cationic, cellulose based polyelectrolyte JR 400 and the anionic surfactant sodium dodecylbenzene sulfonate (LAS) have been used to control the rheological behaviour of aqueous solutions. Around charge equilibrium precipitation takes place, but both for the surfactant-rich and the polymer-rich side homogeneous solutions are formed. In these monophasic regions the rheology depends strongly on the mixing ratio between the two components and highly viscous systems can be obtained on the polyelectrolyte rich side upon the addition of relatively small amounts of surfactant. Here the viscosity increases by more than four orders of magnitude before reaching the phase boundary of precipitation. Small-angle neutron scattering (SANS) showed the formation of an interconnected network of rodlike aggregates composed of a polyelectrolyte/surfactant complex, which explains the observed high viscosity due to the high degree of interconnection by the polyelectrolyte.

Nonlinear behavior of nematic platelet dispersions in shear flow

Dispersions of platelets in the nematic phase are submitted to large amplitude oscillatory shear flow and probed by high temporal resolution small angle x-ray scattering. The response displays rich dynamic and structural behavior. Under small amplitude deformations we observe an elastic response, while structurally symmetry is broken: a preferential direction of deformation is selected which induces off-plane orientation of the platelets. We associate the elastic responses with the tilting director of the platelets towards the flow direction at all strain amplitudes. At large strain amplitudes there is a yielding transition between elastic and plastic deformation, accompanied by a flipping of the director. At intermediate strain amplitudes the director has a rich dynamic behavior, illustrating the complex motion of platelets in shear flow. These observations are confirmed by steady-shear flow reversal experiments, which underline the unique character of sheared nematic platelet dispersions.

Is there a need for early post-operative x-rays in primary total knee replacements? Experience of a centre in the UK

INTRODUCTION

Early post-operative x-rays are often taken in total knee replacements (TKRs). Patient mobilisation may be delayed until these x-rays are obtained and this may prolong discharge. The aim of this study was to assess the value of such early x-rays and whether they influenced the early post-operative management of these patients.

METHODS

A total of 624 consecutive TKRs performed at the Blackpool Victoria Hospital over a 34-month period were evaluated. Plain anteroposterior and lateral x-rays were examined.

RESULTS

Two patients were found to have significant abnormalities: an undisplaced periprosthetic tibial fracture and a partial inferior pole patellar avulsion. Neither of these required further treatment or influenced mobility. No other complications were noted that changed routine post-operative management.

CONCLUSIONS

These results question the need for immediate x-rays in primary TKRs.