bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences in outcomes after aortic aneurysm surgery should foster further research to improve screening and prevention programmes
Authors: Nicolini Francesco , Vezzani Antonella , Corradi Francesco , Gherli Riccardo , Benassi Filippo , Manca Tullio , Gherli Tiziano 
Published: April 2018

BackgroundGender-related biases in outcomes after thoracic aortic surgery are an important factor to consider in the prevention of potential complications related to aortic diseases and in the analysis of surgical results.MethodsThe aim of this study is to provide an up-to-date review of gender-related differences in the epidemiology, specific risk factors, outcome, and screening and prevention programmes in aortic aneurysms.ResultsFemale patients affected by aortic disease still have worse outcomes and higher early and late mortality than men. It is difficult to plan new specific strategies to improve outcomes in women undergoing major aortic surgery, given that the true explanations for their poorer outcomes are as yet not clearly identified. Some authors recommend further investigation of hormonal or molecular explanations for the sex differences in aortic disease. Others stress the need for quality improvement projects to quantify the preoperative risk in high-risk populations using non-invasive tests such as cardiopulmonary exercise testing.ConclusionsThe treatment of patients classified as high risk could thus be optimised before surgery becomes necessary by means of numerous strategies, such as the administration of high-dose statin therapy, antiplatelet treatment, optimal control of hypertension, lifestyle improvement with smoking cessation, weight loss and careful control of diabetes. Future efforts are needed to understand better the gender differences in the diagnosis, management and outcome of aortic aneurysm disease, and for appropriate and modern management of female patients.
Geographically Localized Medicine House-Staff Teams and Patient Satisfaction
Authors: Siddiqui Zishan , Bertram Amanda , Berry Stephen , Niessen Timothy , Allen Lisa , Durkin Nowella , Feldman Leonard , Herzke Carrie , Qayyum Rehan , Pronovost Peter , Brotman Daniel J 
Published: April 2018

Background: Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood. Objective: To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period. Participants: Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams’ home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients. Measurement: Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys. Results: There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%; P = .54) or that staff were better at working together (63.2% vs 61.3%; P = .29). This did not change during a 45-month period when the proportion of patients on home units exceeded 75% and multidisciplinary rounds were started. Conclusion: Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.
Efficacy and Safety of Adalimumab Treatment in Patients with Moderate to Severe Psoriasis: A Double-Blind, Randomized Clinical Trial
Authors: Gordon Kenneth B. , Blum Robin R. , Papp Kim A. , Matheson Robert , Bolduc Chantal , Hamilton Tiffani , Heffernan Michael , Alan Menter M. , Okun Martin M. , Zhong Jianhua , Kaul Martin , Camez Anne 
Published: April 2018

Background Tumor necrosis factor-alpha (TNF-α) is pivotal in the pathogenesis of psoriasis, an immune-mediated disease. Adalimumab is a fully human, IgG1 monoclonal antibody that inhibits TNF-α. Objectives The aims of this study were to assess the efficacy and safety of adalimumab therapy for patients with moderate to severe plaque psoriasis and evaluate the duration of treatment response after withdrawal from or dosage reduction of adalimumab therapy. Methods In this multicenter, randomized, double-blind, placebo-controlled study, patients with moderate to severe plaque psoriasis received 12-week, open-label therapy with subcutaneous adalimumab, consisting of 80 mg of adalimumab at weeks 0 and 1, followed by 40 mg weekly at weeks 2–11. At week 12, patients who had an improvement in Psoriasis Area and Severity Index (PASI) score of ≥50% were randomized to blinded therapy and received either adalimumab 40 mg every other week (eow) or placebo for an additional 12 weeks. Results A total of 148 patients enrolled. Clinical response was rapid, with a PASI 50 response rate of 28% at week 2 of adalimumab therapy. At week 12, 91.9% (136/148) of patients had achieved ≥50% reduction in PASI (PASI 50) vs. baseline, 76.4% (113/148) had achieved PASI 75, and 47.3% (70/148) had achieved PASI 90. Of patients who were randomized to placebo at week 12, 30.9% (21/68) experienced a relapse (<PASI 50 improvement vs. baseline) by week 24, compared with 16.2% (11/68) of patients who received adalimumab 40 mg eow. In addition, 48.5% (33/68) of patients who were randomized to placebo at week 12 were PASI 75 responded at week 24, compared with 67.6% (46/68) of patients randomized to adalimumab 40 mg eow (p=0.032). And, 27.9% (19/68) of patients who were randomized to placebo at week 12 were PASI 90 responders at week 24, compared with 47.1% (32/68) of patients randomized to adalimumab 40 mg eow (p=0.028). Adalimumab was generally well-tolerated, and the rates of adverse events were comparable between the adalimumab and placebo groups. Conclusions Weekly adalimumab therapy rapidly improved psoriasis during an initial 12-week period. Improvement was sustained in most, but not all patients, despite dosage reduction to every other week. No patients randomized to adalimumab withdrawal (placebo at week 12) experienced rebound, and most maintained >PASI 50 improvement, relative to baseline, during the 3 months following adalimumab discontinuation. Overall, greater efficacy rates at week 24 were observed for patients randomized to continuous adalimumab therapy than for patients who were withdrawn from therapy at week 12.
A Randomized, Double-Blind, Vehicle-Controlled, Right/Left Comparative Study of the Efficacy of Acitretin with and without the Co-Administration of 0.1% Tacrolimus Topical Ointment in the Treatment of Moderate to Severe Psoriasis
Authors: Nelson Andrew A. , Krejci-Manwaring Jennifer , Carroll Christie L. , Ann McCarty Martha , Willard Joy , Fleischer Alan B. , Feldman Steven R. 
Published: April 2018

Background Topical tacrolimus is effective as monotherapy for inverse psoriasis. Its use in combination with other systemic agents may be an effective treatment for psoriasis in less sensitive areas. Objective To determine if topical tacrolimus in combination with oral acitretin is more effective than oral acitretin and vehicle ointment. Methods All patients received oral acitretin; subjects were randomized to apply topical tacrolimus to one side of their body and vehicle to the other. Results Topical tacrolimus was more effective than vehicle ointment as early as week 4. There were no serious adverse events thought to be due to drug or dose changes during the study. Limitations Due to the short time horizon of the study, it may not be appropriate to generalize the results to longer treatment periods. Conclusions Topical tacrolimus is an effective psoriasis treatment and was well-tolerated when combined with systemic acitretin in the treatment of psoriasis.
Consistency of Infliximab Response across Subgroups of Patients with Psoriasis: Integrated Results from Randomized Clinical Trials
Authors: Reich Kristian , Menter Alan , Plotnick Michael , Guzzo Cynthia , Li Shu , Gottlieb Alice B. 
Published: April 2018

Background To assess the consistency of infliximab (Remicade) response among different subgroups of patients with moderate to severe psoriasis, the impact of gender, obesity, age, baseline psoriasis severity, concomitant psoriatic arthritis (PsA), or prior therapies on response to infliximab was studied in an integrated efficacy analysis. Methods Data from three randomized, placebo-controlled clinical trials (SPIRIT, EXPRESS and EXPRESS II) that evaluated the use of infliximab in patients with moderate to severe psoriasis were included in this integrated analysis. Patients received placebo, infliximab 3 mg/kg, or infliximab 5 mg/kg at 0, 2 and 6 wks. The common primary end point at week 10 was the proportion of patients achieving ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) from baseline. Safety data through week 16 were pooled for analysis. Results Of the 1,462 patients included in this analysis, 70.6% and 79.3% in the infliximab 3 and 5 mg/kg groups, respectively, achieved at least a PASI 75 response at week 10, compared with 2.7% in the placebo group (both p<0.001). The proportions of patients achieving PASI 75 at week 10 were consistent in subgroups defined by baseline demographic characteristics (gender, age, body mass index) and also defined by baseline disease characteristics (PASI severity, body surface area, presence of psoriatic arthritis). Consistent results were also observed regardless of psoriasis therapeutic history. Infliximab treatment was generally well-tolerated by the majority of study participants. Conclusion A consistently high level of clinical response to infliximab was demonstrated across subgroups defined by a variety of baseline demographic and disease characteristics in patients with psoriasis. Infliximab was similarly effective regardless of previous use of phototherapy or major conventional systemic therapies.
Purine Synthesis Inhibitors, 6-thioguanine and Azathioprine: Forgotten Treatment Options in Psoriasis and Psoriatic Arthritis
Authors: Nguyen Thao , Koo John 
Published: April 2018

Background The thiopurine drugs azathioprine and 6-thioguanine have been shown to induce significant clinical improvement in patients with moderate to severe psoriasis and/or psoriatic arthritis. Objective The aim of this paper is to present a comprehensive review of the available literature concerning the off-label role of thiopurine drugs in the treatment of psoriasis and psoriatic arthritis. Methods Studies published with English abstracts between 1960 and 2008 identified in MEDLINE and PubMed with the keywords purine synthesis inhibitors, thiopurine, 6-thioguanine, azathioprine, psoriasis and psoriatic arthritis were reviewed. Results Although 6-thioguanine and azathioprine have shown significant efficacy, their side effect profiles have discouraged their use for moderate to severe psoriasis. Conclusion For treatment of psoriasis and psoriatic arthritis, purine synthesis inhibitors should not be forgotten. They represent an entirely different option and provide an alternative therapy, especially for difficult cases.
Efalizumab: What Went Wrong?
Authors: Bryant Douglas , Ayoub Nedhal 
Published: April 2018

Efalizumab was approved for psoriasis in 2003. In 2008, two cases of progressive multifocal leukoenecephalopathy (PML) were reported, and in 2009, a third case was confirmed in patients on efalizumab monotherapy for psoriasis. As a result, in Europe, efalizumab's marketing authorization was suspended by the European Medicines Agency. Shortly thereafter, Genentech announced plans to withdraw the drug from the U.S. The withdrawal, which was completed in June 2009, was the result of the risk of an infection that is often fatal, with three confirmed PML cases out of the approximately 2,000 patients treated with efalizumab for more than three years. Efalizumab was one of the first biologics approved by the U.S. Food and Drug Administration for the treatment of moderate to severe plaque psoriasis. With the later approval of additional biologic agents for plaque psoriasis, prescribers had additional treatment options with improved efficacy and safety. The risks associated with efalizumab for its relatively low efficacy made it unattractive compared to other biologic product treatment options, ultimately leading to its withdrawal.
IL-12/23 Inhibitors and Their Potential Benefits and Risks for Psoriasis Patients
Authors: Kinney Megan A. , Yentzer Brad A. , Feldman Steven R. 
Published: April 2018

Background Interleukin (IL)-12 and IL-23 are implicated in the pathogenesis of psoriasis and new IL-12/23 inhibitors are currently being studied for psoriasis treatment. Objective To review the literature and provide an update on the current use of anti-IL-12/IL-23 therapies for psoriasis, with special emphasis on risks and benefits. Methods A PubMed search was performed to identify articles in English with key words “Ustekinumab and psoriasis,” “IL-12 and IL-23 and psoriasis,” “ABT-874 and psoriasis,” “IL-12/23 monoclonal antibody,” “IL-12/23 antibody” and “CNTO-1275.” Supplemental methods included Google Scholar, article reference lists and scholarly posters. Results Anti-IL-12/23 therapies may be more effective for psoriasis treatment than concurrent biologics. However, there is a potential risk of compromising cancer surveillance mechanisms through blocking IL-12. Limitations More research is needed into the long-term effects of anti-IL-12/23 agents. Conclusions Convenient dosing of ustekinumab and greater efficacy make the anti- IL-12/23 agents a promising therapeutic option.
The Self-Administered Psoriasis and Arthritis Screening Questionnaire (PASQ): A Sensitive and Specific Tool for the Diagnosis of Early and Established Psoriatic Arthritis
Authors: Khraishi Majed , Landells Ian , Mugford Gerry 
Published: April 2018

Background Psoriatic arthritis is a serious chronic inflammatory arthritis that can lead to significant joint damage and often is associated with comorbidities. Early detection and effective management of psoriatic arthritis may prevent the development of such complications. Most patients develop psoriatic arthritis years after onset of psoriasis, and most patients with psoriasis alone are managed by dermatologists or general practitioners. These clinicians are thus in an excellent position to screen for psoriatic arthritis early in the disease course. Objective The objective of this study was to evaluate the sensitivity and specificity of the Psoriasis and Arthritis Screening Questionnaire (PASQ) in detecting patients with psoriatic arthritis. Methods Two groups of patients were screened: patients with established disease and patients referred for evaluation of possible (i.e., early) psoriatic arthritis. Results In patients with established disease, analysis of the PASQ score yielded an optimal cutoff point of 9 with 86.27% sensitivity and 88.89% specificity. In patients with early disease, the PASQ indicated an optimal score of 7 with 92.86% sensitivity and 75% specificity. Conclusion The PASQ is an effective screening tool in psoriatic arthritis patients with a long history of disease as well as in those with short disease duration.
Comorbidities in Psoriasis
Authors: Kogan Nora , Veira Rosana , Chaparro Elena , Crespo Alejandra , Gusis Simón , Hassan Mercedes 
Published: April 2018

Objective To assess whether psoriasis comorbidities modify the disease. Material and Methods In 170 patients with psoriasis, we considered the following comorbidities: hypertension, metabolic syndrome, diabetes, dyslipidemia, overweight, cardiovascular disease, liver disease, and thyroid diseases. We compared patients with any number of comorbidities to patients without comorbidities, and we also compared patients with one, two, or three or more comorbidities to patients who lacked comorbidities. Results We identified 62 patients (36%) without comorbidities and 108 patients (64%) with comorbidities. Only age, duration of the disease, and guttate psoriasis showed statistically significant correlation with comorbidities. When the group without comorbidities was compared with the groups of patients with differing numbers of comorbidities, we found significant differences only in age and duration of the disease. Conclusions The presence and the increased number of comorbidities were associated with advanced age and greater duration of the disease, whereas guttate psoriasis had an inverse relation with concomitant diseases.
A Practical Approach to the Use of Methotrexate
Authors: Busse Kristine , Koo John 
Published: April 2018

Background Methotrexate is approved by the Food and Drug Ad ministration for the treatment of severe, recalcitrant, and disabling psoriasis that is not adequately responsive to other forms of therapy. It is a systemic immunosuppressant that requires appropriate patient selection, screening laboratory values, and close monitoring before initiation of a maintenance regimen. Purpose This clinical review outlines a practical approach for the use of methotrexate in psoriasis. Methods A review of English-language literature between 1950 and 2010 was conducted, and the results are presented here. Results With close monitoring and appropriate patient selection, methotrexate is often an effective treatment option for moderate to severe psoriasis. Attention to individual patient risk factors and understanding of dosing regimens, contraindications, and “black box” warnings regarding methotrexate use can assist dermatologists in safely prescribing methotrexate for psoriasis treatment. Limitations This practical approach is based on an extensive literature review and the National Psoriasis Foundation and American Academy of Dermatology guidelines formulated after years of clinical practice, newer efficacy trials, and expert consensus regarding management in psoriasis patients. We have additionally incorporated some recommendations from our clinical experience at the University of California-San Francisco Psoriasis Treatment Center as indicated in the text. As always, clinical judgment and risk assessment should be used in selecting appropriate psoriasis patients for methotrexate therapy. Conclusion Methotrexate remains an effective, less expensive, and safe option for psoriasis patients who were previously unresponsive to other forms of therapy.
Adalimumab Treatment and Work Productivity in Patients with Moderate to Severe Psoriasis: Results from a Prospective Clinical Trial
Authors: Bhutani Tina , Patel Tejas , Koo Bonnie 
Published: April 2018

Objective The effect of adalimumab on work productivity and occupational functioning was evaluated in patients with moderate to severe psoriasis during a prospective 24-week open-label, single-center trial. Methods Thirty-four patients received adalimumab 80 mg subcutaneously at week 0, followed by 40 mg every other week from weeks 1 through 24. Patients were allowed to continue previous topical treatments and phototherapy while enrolled. Occupational functioning was evaluated at monthly intervals throughout the study using the Work Productivity and Activity Impairment Questionnaire—Specific Health Problem. Results There was a statistically significant improvement from baseline to week 24 in the percent of impairment while working (P = 0.0029) and in the percent of overall work impairment (P = 0.0026). The percent of work time missed because of psoriasis decreased, but this change did not reach statistical significance (P = 0.11). Conclusion Adalimumab was efficacious in improving work and activity limitations in patients with moderate to severe psoriasis over a 24-week period.
A Review of Drugs that Induce or Exacerbate Psoriasis
Authors: Hong Julie , Bernstein Daniel 
Published: April 2018

Background Psoriasis is a common disorder of the skin, immune system, and joints that is influenced by genetic and environmental factors. It can be aggravated or induced by drugs. Objectives To identify the major drugs implicated in inducing or exacerbating psoriasis and to discuss their characteristics. Methods We performed a PubMed literature search for reviews and case reports on drugs that exacerbate or induce psoriasis. Articles were screened by title and abstract and then examined for their findings and references. Results Drugs most often reported to exacerbate or induce psoriasis were β-blockers, lithium, synthetic antimalarials, nonsteroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, interferons, tetracyclines, tumor necrosis factor-α inhibitors, and steroid withdrawal. Conclusions Characterizing drugs that induce or exacerbate psoriasis by latency and type of psoriatic eruption can help guide clinical reasoning. Although a relatively uncommon occurrence, psoriatic lesions can be caused by drugs, allowing astute physicians to recognize and change their management plans accordingly.
The Unique Impact of Psoriasis on the Geriatric Population: A Review
Authors: Wong Jillian W. , Koo John Y. M. 
Published: April 2018

Background The geriatric population is growing steadily worldwide; therefore, greater emphasis on optimizing care for this patient population is needed. Psoriasis in particular has the highest rate of occurrence in the geriatric age group compared with younger cohorts. It also has a significant negative impact, both physically and psychologically, on the geriatric population. Psoriasis therapies that include immunosuppressive agents can be more risky to the elderly patients with age-related comorbidities. Objective We present a literature review of the unique impact of psoriasis on older patients. Methods A search of PubMed's MEDLINE database of articles published from 2000 to 2011 was performed, and 57 articles were included in the review. Results Multiple unique physical and psychological challenges from psoriasis affecting the geriatric population were identified. The use of systemic immunosuppressive therapies requires special consideration for the less healthy segment of the elderly population. Conclusions Very little research specifically examining the geriatric population with psoriasis has been performed. More focused research is needed to determine how to treat these patients optimally and improve the quality of life for this unique subset of patients with psoriasis.
Bipolar disorder, comorbid anxiety disorders, gynecomastia and dental pain: case analysis with literature review
Authors: Kaufman Kenneth R. , Babalola Ronke , Campeas Miriam , Coluccio Melissa 
Published: April 2018

Bipolar disorder with comorbid anxiety disorders frequently requires rational polypharmacy, including use of serotonergic psychotropics. These may result in adverse effects, influencing adherence, complicating treatment and confounding diagnoses. Serotonergic non-adherence is associated with discontinuation syndromes. In this complex case with an on/off/on/off design, both dose-dependent buspirone-induced gynecomastia and buspirone discontinuation syndrome with dental pain are reported. Clinicians and patients should consider these findings to maximise treatment adherence, minimise any unnecessary interventions and address unusual adverse effects. Since patients may not voluntarily disclose specific adverse effects and often do not acknowledge non-adherence, clinician-directed questions are required. This case further emphasises the importance of medication and symptom timelines to guide determination of causation for adverse effects. Although findings from this case cannot be generalised, they suggest the need for continued clinician and patient education, as well as the benefit from detailed case reports.Declaration of interestNone.