Mcmillankokholm6727

To examine the accuracy of dual-energy computed tomography (DECT) vs ultrasound or their combination for the diagnosis of gout.

Using prospectively collected data from an outpatient rheumatology clinic at a tertiary-care hospital, we examined the diagnostic accuracy of either modality alone or their combination, by anatomical site (feet/ankles and/or knees), for the diagnosis of gout. We used two standards (1) demonstration of monosodium urate crystals in synovial fluid (gold), and (2) modified (excluding DECT and ultrasound) 2015 ACR-EULAR gout classification criteria (silver).

Of the 147 patients who provided data, 48 (33%) had synovial fluid analysis performed (38 were MSU-crystal positive) and mean symptom duration was 9.2 years. 100 (68%) patients met the silver standard. Compared with the gold standard, diagnostic accuracy statistics for feet/ankles DECT, feet/ankles US, knees DECT, and knees ultrasound were sensitivity, 87%, 84%, 91%, 58%; specificity, 100%, 60%, 87%, 80%; PPV, 100%, 89%, 97%, 92%; NPV, 67%, 50%, 70%, 33%; AUC, 0.93, 0.72, 0.89, 0.66. Combining feet/ankles DECT with ultrasound or knees DECT with ultrasound led to a numerically higher sensitivity compared with DECT alone, but overall accuracy was lower. Similarly, combining imaging knees to feet/ankles also yielded a numerically higher sensitivity and NPV compared with feet/ankles DECT alone, without differences in overall accuracy. Findings were replicated compared with the silver standard, but with lower numbers.

Feet/ankles or knees DECT alone had the best overall accuracy for gout diagnosis. DECT/US combination or multiple joint imaging offered no additional increase in overall diagnostic accuracy.

Feet/ankles or knees DECT alone had the best overall accuracy for gout diagnosis. DECT/US combination or multiple joint imaging offered no additional increase in overall diagnostic accuracy.

To evaluate three-year outcomes of following a treat-to-target (T2T) strategy targeting low disease activity (LDA) for patients with elderly-onset rheumatoid arthritis (EORA) and to confirm safety profile of T2T.

Treatment was adjusted to target LDA with conventional synthetic DMARDs, followed by biological DMARDs (bDMARDs) in 197 MTX-naïve EORA patients (mean age 74.9 years) with moderate-to-high disease activity. Non-implementation of T2T was evaluated at week 12, 24, 36, 52, 76, 104, and 128. To evaluate risks of using MTX, bDMARDs, and glucocorticoids, 2122 periods of 3 months each were analyzed using Bayesian hierarchical logistic regression models.

84.7% of patients received methotrexate, 34.0% glucocorticoids with DMARDs and 41.6% bDMARDs during the observation period. Sixty-nine of the 197 patients failed to adhere to T2T because of comorbidities or the patient´s own decision 33 failed once, 19 twice, 10 three times, and 6 four times or more. Simplified disease activity index (SDAI) remission and HAQ Disability Index (HAQ-DI) ≤0.5 at 3 years were achieved in 57.8% and 70.3% of the 128 patients adhering to T2T, and 34.8% and 43.5% of the 69 patients who did not adhere to T2T, respectively, and these were significantly different. Eighty-nine SAEs of any type were reported in 61 patients. MTX, bDMARDs, and glucocorticoid were not associated with SAEs when adjusted for mean SDAI during the observation period and comorbidities at baseline.

T2T strategy for EORA by using MTX and bDMARDs was effective with acceptable safety profile. Adhering to T2T led to better outcomes.

T2T strategy for EORA by using MTX and bDMARDs was effective with acceptable safety profile. selleck chemicals Adhering to T2T led to better outcomes.Non-communicable diseases (NCDs) are the leading cause of death and disability in the world with the majority of deaths occurring in low- and middle-income countries (LMICs). The financial implications of disease and disability due to NCDs, combined with the costs of long-term management, are major causes of impoverishment and serve as barriers to socio-economic development. The transition from infectious diseases to NCDs as leading causes of mortality in LMICs is driven by several factors, primarily increasing globalization, urbanization, ageing of populations and economic development. Responding to these challenges will require local and comprehensive primary and secondary prevention efforts. The World Health Organization's Global Action Plan provides a road map and an array of policy options to achieve nine voluntary global targets by 2025. The primary responsibility of governments in responding to the challenge of NCDs includes international scientific cooperation to support national and local efforts. The implementation of such efforts to prioritize the prevention of NCDs will create an environment in which the rising trend of the NCD burden could be potentially halted and reversed. When developing NCD policies, stakeholders should consider evidence-based strategies which can be implemented by multidisciplinary teams that are led or have the participation of behavioral medicine scientists. Behavioral medicine strategies should be incorporated into the policy and intervention framework developed to target NCDs in LMICs.Sickle cell disease (SCD) is an inherited hemoglobinopathy that leads to blood vessel occlusion and multiorgan complications, including pain, that may be experienced daily. Symptom management often begins at home, and tools are needed to support self-management strategies that can be implemented by children with SCD and families. The purpose of this study was to assess the feasibility of the mHealth self-management intervention (application) Voice Crisis Alert V2 for children with SCD and families. Feasibility assessment was guided by the Reach, Efficacy, Adoption, Implementation, and Maintenance framework. Data were collected with 60 dyads (children with SCD/caregivers) at four time points. Self-management data were collected via application use, and postintervention interviews were conducted. Analyses included descriptive statistics and constant comparison with directed content analysis. Recruitment was completed in 28 weeks, with 82% retention at end-of-intervention. Mobile Application Rating Scale scores and interview data indicated high satisfaction.