bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes for patients with RA: a rheumatology nurse practitioner clinic compared to standard outpatient care
Authors: Hill Jackie , Thorpe Ruth , Bird Howard 
Published: February 2006

AbstractObjectives:The study aimed to extend our previous work by comparing the outcome of patients with rheumatoid arthritis (RA) attending a rheumatology nurse practitioner (RNP) clinic with those of patients attending the more traditional junior hospital doctor's clinic (JHD).Method:A randomised controlled trial of 80 people with RA were allocated to either an RNP or JHD clinic and seen six times in 12 months. The primary outcome measure was the DAS28. Secondary measures included stiffness, fatigue, physical function, psychological status, knowledge and satisfaction.Results:Number of patients: RNP 39 (8 males); JHD 41 (9 males). Age of patients: RNP 36–76 years (median 57); JHD 35–74 years (median 57). Median disease duration: RNP 12 years (range 2–40); JHD 17 years (range 1.5–41). Years of full time education: RNP 8–17 years (median 10); JHD 9–20 years (median 10). Week 48 DAS scores compared to baseline: RNP 19 unchanged, 6 worse and 11 better; JHD 22 unchanged, 7 worse, 6 better. Length of morning stiffness increased significantly at week 24 (p = 0.05) in the JHD cohort but improved to become non‐significant at week 48 (p = 0.09). By week 48 fatigue had improved in the RNP cohort (p = 0.038) and deteriorated in JHD patients (p = 0.008). The AIMS showed decreases in pain in the RNP cohort (p = 0.044) and worsening physical function in JHD patients (p = 0.038). Patient satisfaction in the RNP cohort increased significantly (overall satisfaction p = 0.000). The JHD cohort showed a decrease in satisfaction with access and continuity (p = 0.027).Conclusions:The findings from this research confirm that care from the RNP is both effective and safe. Furthermore, a specialist RNP can bring additional benefits in the form of greater symptom control and enhanced patient self‐care. Copyright © 2003 Whurr Publishers Ltd.
Developing a service for biologic therapies: a personal experience
Authors: Somerville Margaret 
Published: February 2006

AbstractTumour necrosis factor alpha (TNFα) has been identified in the pathogenesis of synovitis and joint destruction in rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). Therefore selected targeting of pathogenic elements of disease is possible (Chu et al., 1991). TNFα is a pro‐inflammatory cytokine (mediator) and the over‐expression of mediators is considered to be responsible for the damage to articular cartilage in bones. Elevated levels of TNFα, correlating with disease activity, have been measured in the serum and synovial fluid of patients with rheumatic diseases and are therefore an ideal target for therapy (Mangge et al., 1995; Cope et al., 1992). The National Institute for Clinical Excellence (NICE) approved the use of two therapies; entanercept (Enbrel) and infliximab (Remicade) for use in patients with active RA in 2002 (NICE, 2002). Other biologic treatments including adalimumab (D2E7) and anakinra (Kineret) will also be available for use in the future. This paper explores the development of a service to provide these therapies to patients. Copyright © 2003 Whurr Publishers Ltd.
The immune system and new therapies for inflammatory joint disease
Authors: Oliver Susan M. 
Published: February 2006

AbstractThis article provides an overview of the immune system with a specific focus on the role of biologic therapies in treating the consequences of an altered immune response as seen in rheumatoid arthritis (RA). Cytokines are powerful chemical messengers that have a significant role to play in activating an inflammatory response. Two dominant cytokines have been identified as crucial in the inflammatory process that can be seen in RA – tumour necrosis factor alpha (TNFα) and interleukin‐1. The term ‘biologic’ is used to describe biologically engineered therapies that are specifically designed to prevent pro‐inflammatory cytokines inducing an inflammatory response. Research trials and now clinical practice have clearly demonstrated a significant benefit to patients receiving biologic therapies. The responsibility of the practitioner is to ensure a sound knowledge of biologic therapies, to understand the essential aspects of care and to recognize the importance of guidance documents available to support management and, ultimately, the long‐term provision of safe and effective administration of these therapies. Copyright © 2003 Whurr Publishers Ltd.
A new dawn: a consultant physiotherapist in musculoskeletal disease
Authors: Stevenson Kay 
Published: February 2006

AbstractA new dawn has occurred with the creation of new occupational roles for allied health professionals (AHPs). This paper explores the key components of the consultant physiotherapist's role and gives examples to illustrate how the role can be applied in the context of the management of patients presenting with musculoskeletal conditions. Copyright © 2003 Whurr Publishers Ltd.
Control perceptions in patients with rheumatoid arthritis: the role of social support
Authors: Ryan Sarah , Hassell AB , Dawes PT , Kendall Sally 
Published: February 2006

AbstractObjective:To identify factors that patients perceive as influencing control in living with rheumatoid arthritis.Method:A sample of 40 patients with rheumatoid arthritis were randomly recruited from an outpatient population and partook in an in depth, qualitative interview by one researcher to identify control perceptions. The data were analysed utilizing Colaizzi's procedural steps.Results:Four major categories were identified that positively influenced control perceptions:

The reduction of physical symptoms.
Social support matching perceived need.
The provision of information.
The nature of the clinical consultation.
Three components were identified in relation to social support:

Remaining involved in family activities.
Ongoing support from family members.
Achieving a balance between support needs and support provision.
Conclusion:The categories identified can be influenced by practitioners enabling patients with RA to obtain perceived control over their condition. Copyright © 2003 Whurr Publishers Ltd.
Clinical governance: the ethical dimension
Authors: Ford Lyn 
Published: February 2006

AbstractThe main thrust of the Government's White Paper ‘A First Class Service: Quality in the new NHS’ (DOH, 1998) was to tackle the issues of quality and modernization in health services. While in part, clinical governance was aligned with positive, developmental and collaborative approaches to quality improvement, it was also designed to protect service users from risks associated with poor performance. Certainly there was more than a suggestion that the implementation of clinical governance would help restore public confidence in health professionals and care delivery. In essence clinical governance for Trusts was intended as a single, coherent local programme for quality improvement. Quality was to infuse all aspects of service delivery and unite fragmented policies and approaches. Clinical governance was also to challenge indifferent organizational cultures and connect grass roots staff to the quality agenda, so encouraging the widespread adoption of the principles and methods of continuous quality improvement. Copyright © 2003 Whurr Publishers Ltd.
A review of the history of hand exercises in rheumatoid arthritis
Authors: Chadwick Anne 
Published: February 2006

AbstractThe management of the hand in the patient with rheumatoid arthritis (RA) is a challenge to all therapists and evidence for optimum management historically scarce. Given that it is estimated that hands and wrists are affected in 80–90% of RA patients (Maini and Feldmann, 1998), it is apparent that this is an important area for both the patient and practitioner. While acknowledging the importance of hand function to the patient with RA (Jones et al., 1991), it should also be admitted that there is little research evidence relating to the conservative management of hand function in this patient population. This paper reviews the research that has been carried out in this area and explores possible areas for further research. Copyright © 2004 Whurr Publishers Ltd.
Biologic agents used to treat rheumatoid arthritis and their relevance to podiatrists: a practice update
Authors: Otter S.J. , Young A. , Cryer J.R. 
Published: February 2006

AbstractThis review considers the pharmacological management of rheumatoid arthritis including the role of anti‐tumour necrosis factor alpha (TNFα) agents, as a precursor to highlighting some of the issues for podiatrists involved in the care of patients on this particular medication. Copyright © 2004 Whurr Publishers Ltd.
Nurse prescribing in rheumatology: a case study
Authors: Hennell Sheena L. 
Published: February 2006

AbstractThis case study outlines the clinical management, and in particular the drug management, of a patient with polymyalgia rheumatica (PMR) in secondary care. The lady in question, Mrs Adams (pseudonym as per NMC Guidelines), is under the care of the consultant rheumatologist. Within this clinical setting, and in conjunction with an appropriate, agreed clinical management plan, this paper demonstrates that the nurse consultant can effectively manage Mrs Adams' care and treatment. Copyright © 2004 Whurr Publishers Ltd.
Pain mechanisms and the rheumatic diseases
Authors: McCabe C.S. 
Published: February 2006

AbstractPain is the predominant complaint of those with a rheumatological condition. This paper provides a broad overview of the current theories on the mechanisms of pain, the structure of the nervous system, and how these may relate to the sometimes seemingly incomprehensible symptoms of pain and other sensory disturbances that some rheumatology patients describe. Three case histories relating to rheumatoid arthritis, osteoarthritis and fibromyalgia are used to illustrate how this knowledge can be applied to clinical practice. Copyright © 2004 Whurr Publishers Ltd.
Drug treatment for fibromyalgia
Authors: Bird Howard A. 
Published: February 2006

AbstractThe term ‘fibromyalgia’ probably covers a variety of diagnoses for which we have no formal diagnostic tests. Nevertheless, it remains a cause of discomfort and disability, often amenable to non‐drug treatment that should always be tried first. This article reviews the different drug treatments available that are of interest to the rheumatology community because the drugs that often procure pain relief are not always the same as those that are conventionally used for degenerative or inflammatory polyarthritis. This, in turn, may provide a clue to causation. Copyright © 2004 Whurr Publishers Ltd.
Occupational balance of women with rheumatoid arthritis: a qualitative study
Authors: Stamm Tanja , Wright Jon , Machold Klaus , Sadlo Gaynor , Smolen Josef 
Published: February 2006

AbstractObjective:Occupational balance has been shown to be an important factor in maintaining health. Rheumatoid arthritis (RA) reduces functional ability and quality of life and may thus reduce occupational balance. The aim of this qualitative pilot study was to explore occupational balance in women who have RA.Methods:Nine women with RA with past, but not current, paid work experience, no other confounding neuro‐motor disease and with disease duration of 0.75–31 years were selected from an Austrian rheumatology outpatient clinic. Age range of the participants was 28–68 years. A semi‐structured interview was conducted with each participant and transcribed verbatim. Data were analysed by the constant comparative method from an occupational perspective.Results:Three main categories emerged: (1) The participants experienced a process of change that affected their occupational balance. (2) This new state of occupational balance was characterized by changed levels of involvement in physical, mental, social and rest occupations and by a certain level of unpredictability of symptoms. (3) Overall, the new state of occupational balance was valued differently: positively, indifferently or negatively. Conclusion: RA was found to have a considerable impact on occupational balance. The experience is not invariably seen as negative as previous literature would suggest. Further research should explore the longitudinal dimension of occupational balance in people with RA. Copyright © 2004 Whurr Publishers Ltd.
Rehabilitation in rheumatoid arthritis: a critical review
Authors: Hammond Alison 
Published: February 2006

AbstractThis article considers the evidence for effectiveness and timing of rehabilitation for people with rheumatoid arthritis (RA). The Cochrane Library, DARE, Medline, Embase, CINAHL and AMED were searched to identify systematic reviews and randomized controlled trials evaluating rehabilitation interventions for people with rheumatoid arthritis. Many trials identified had methodological limitations (e.g. short follow‐up periods, small sample sizes). Evidence to date is that symptomatic relief results from thermotherapy, laser therapy, acupuncture and assistive devices. In the short‐term, comprehensive occupational therapy (in established rheumatoid arthritis), orthoses, and mind–body approaches can help maintain function. Over at least a one‐year period, the following are effective in reducing pain and maintaining function: patient education and joint protection training using behavioural approaches; dynamic exercise therapy, hand exercises and hydrotherapy; and cognitive‐behavioural therapy (in people with poorer psychological status). Many trials have recruited people with moderate to severe, established RA and relatively little is known about the long‐term effectiveness of early rehabilitation, although this is becoming much more common in practice. Despite the increased availability of guidelines and systematic reviews, most conclude there is insufficient evidence for many areas of rheumatology rehabilitation. Further well‐designed clinical trials are needed recruiting people with early disease using patient‐centred outcomes. Copyright © 2004 Whurr Publishers Ltd.
The role of social comparison in coping with rheumatoid arthritis: an interview study
Authors: Hooper Helen , Ryan Sarah , Hassell Andrew 
Published: February 2006

AbstractObjective:This study aimed to explore the effects of participants' perceptions of support, ways of coping and feelings of control, on their accounts of well‐being.Methods:Semi‐structured interviews were conducted with 10 patients with rheumatoid arthritis (RA) and explored the dynamics of participants' accounts of coping with their everyday lives.Results:Four categories of coping mechanisms were evident in all participants' accounts: support during the medical consultation, nurse support, social support, and comparative strategies. This paper focuses on just one of the themes that emerged from our analysis. Further insight into coping mechanisms was provided by the prevalence of comparative coping strategies. A comparison with previous disease states was used by every participant. This comparison enhanced their sense of control and fostered a sense of well‐being. Social comparison was used by seven participants to show themselves how fortunate they were in relation to others with RA.Conclusion:Comparative coping has been identified as an important strategy adopted by these participants that could be explored in further intervention‐based studies of coping. Copyright © 2004 Whurr Publishers Ltd.
The impact of group education on participants' management of their disease in lupus and scleroderma
Authors: Brown Susan J , Somerset Maggie E , McCabe Candy S , McHugh Neil J 
Published: February 2006

AbstractObjectives:The aim of this study was to investigate the impact of the pilot education programmes, entitled ‘Focus on Lupus’ and ‘Focus on Scleroderma’, upon participants' management of their disease.Methods:Five people with lupus and five with scleroderma were invited to take part in individual semi‐structured interviews. Qualitative analysis of transcripts was performed using a framework approach. Views relating to changes in knowledge and behaviour, increased empowerment, meeting others and the format and delivery of the programmes were explored.Results:Analysis of the interviews revealed overall satisfaction with both programmes, however people with lupus had more positive feelings about their attendance. Both disease groups considered it valuable to meet others with the same disease and welcomed the involvement of a patient educator within the programme planning team. The main difference between the two groups concerned behaviour change. The lupus group revealed more definite life changes. Participants unanimously regarded the format of the programme highly and most were satisfied with the content. Copyright © 2004 Whurr Publishers Ltd.
An introduction to medical statistics for health care professionals: describing and presenting data
Authors: Thomas Elaine 
Published: February 2006

AbstractThis article is the first in a series of three that will give health care professionals a sound and helpful introduction to medical statistics. This article covers three main areas: description of the different types of data available, appropriate summary measures used to describe different data types, and methods used to present these data. Copyright © 2004 Whurr Publishers Ltd.
The development of a user‐led clinical service for newly diagnosed rheumatoid arthritis patients. An action research study
Authors: Cox Maureen 
Published: February 2006

AbstractObjective:To identify the clinical services required to meet the perceived needs of patients within the first 6–12 months following a diagnosis of rheumatoid arthritis in an orthopaedic NHS trust.Methods:An action research methodology was utilized. Twenty three newly diagnosed patients were asked to complete a questionnaire focusing on their needs at the time of diagnosis. The content included reactions to diagnosis, physical and psychological implications and clinical services that were required. A sub‐sample of patients (n = 6) participated in an interview to explore these issues in more depth. A questionnaire was also distributed to 14 members of the multidisciplinary team (MDT) to ascertain their views on the purpose, content, and provision of a clinical service for newly diagnosed patients.Results:Eighteen patients agreed to take part (M:F, 9:9, age range 23–74 years, mean age 52.3 years, mean disease duration from diagnosis 16 weeks).Data from the questionnaires and interviews led to the following themes being identified: pre‐diagnosis anxiety and fear, the impact of the diagnosis, physical and psychological implications of the diagnosis, and issues related to control perceptions. There was concordance between the MDT and the patients regarding impact of the disease and the need for information. Areas of the service that were identified independently by patients related to the importance of the period of time pre‐diagnosis while awaiting the hospital appointment, and employment issues.Conclusions:This study has identified the impact of RA in the early stages of pre‐ and post‐ diagnosis on physical, psychological and social functioning and has consequently informed service development. Copyright © 2004 Whurr Publishers Ltd.
Sarcoplasmic reticulum: The dynamic calcium governor of muscle
Authors: Rossi Ann E. , Dirksen Robert T. 
Published: February 2006

AbstractThe sarcoplasmic reticulum (SR) provides feedback control required to balance the processes of calcium storage, release, and reuptake in skeletal muscle. This balance is achieved through the concerted action of three major classes of SR calcium‐regulatory proteins: (1) luminal calcium‐binding proteins (calsequestrin, histidine‐rich calcium‐binding protein, junctate, and sarcalumenin) for calcium storage; (2) SR calcium release channels (type 1 ryanodine receptor or RyR1 and IP3 receptors) for calcium release; and (3) sarco(endo)plasmic reticulum Ca2+‐ATPase (SERCA) pumps for calcium reuptake. Proper calcium storage, release, and reuptake are essential for normal skeletal muscle function. We review SR structure and function during normal skeletal muscle activity, the proteins that orchestrate calcium storage, release, and reuptake, and how phenotypically distinct muscle diseases (e.g., malignant hyperthermia, central core disease, and Brody disease) can result from subtle alterations in the activity of several key components of the SR calcium‐regulatory machinery. Muscle Nerve, 2006
Intranuclear nemaline rod myopathy
Authors: Kaimaktchiev Vassil , Goebel Hans , Laing Nigel , Narus Michael , Weeks Douglas , Nixon Randal 
Published: February 2006

AbstractThe clinical, pathologic, and genetic findings of a boy with intranuclear nemaline rod myopathy are described. Serial muscle biopsies revealed myocyte nuclei containing inclusions that were immunoreactive for α‐actinin and increased with age. Genetic analysis revealed a Val163Leu ACTA1 mutation previously associated with nemaline rod myopathy. Although initially delayed, he has reached all milestones and remains stable. These findings suggest intranuclear rods may increase with time and do not necessarily imply a poor prognosis. Muscle Nerve, 2006
A Generalized Finite Element Method for polycrystals with discontinuous grain boundaries
Authors: Simone A. , Duarte C. A. , Van der Giessen E. 
Published: February 2006

AbstractWe present a Generalized Finite Element Method for the analysis of polycrystals with explicit treatment of grain boundaries. Grain boundaries and junctions, understood as loci of possible displacement discontinuity, are inserted into finite elements by exploiting the partition of unity property of finite element shape functions. Consequently, the finite element mesh does not need to conform to the polycrystal topology. The formulation is outlined and a numerical example is presented to demonstrate the potential and accuracy of the approach. The proposed methodology can also be used for branched and intersecting cohesive cracks, and comparisons are made to a related approach (Int. J. Numer. Meth. Engng. 2000; 48:1741). Copyright © 2006 John Wiley & Sons, Ltd.
Postzygotic isochromosome formation as a cause for false‐negative results from chorionic villus chromosome examinations
Authors: Riegel Mariluce , Wisser Josef , Baumer Alessandra , Schinzel Albert 
Published: February 2006

AbstractObjectiveTo investigate the origin and mechanisms of formation of isochromosomes 13q and 21q in instances where prenatal chromosome examination revealed a normal karyotype while postnatal chromosome examination from blood showed translocation trisomy 13 and 21.MethodsG and/or Q‐banded chromosome examinations from CVS cultures and lymphocyte chromosome examinations from two newborns. Microsatellite marker analysis of DNA from the probands and their parents. Prenatal ultrasonic examinations of the fetuses and postnatal clinical examinations of the probands.ResultsShort and long‐term CVS examinations from two fetuses revealed normal karyotypes. Lymphocyte karyotypes of the newborns showed the karyotype 46,XY,i(21)(q10) in the first case and 46,XY,i(13)(q10) in the second. The isochromosomes 21q and 13q were shown, by microsatellite marker analysis of the patients and their parents, to be of maternal and paternal origin, respectively.ConclusionPostzygotic isochromosome formation is one of the possible mechanisms that may lead to false‐negative results of chorionic villus chromosome examinations, even if both short‐term and long‐term cultures are performed and give normal results. Copyright © 2006 John Wiley & Sons, Ltd.