Responsiveness of the International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis

Background: The comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for rheumatoid arthritis (RA) is a selection of 96 categories from the ICF, representing relevant aspects in the functioning of patients with RA. Objectives: To study the responsiveness of the ICF Core Set for RA in rheumatological practice. Methods: A total of 46 patients with RA (72% women, mean (SD) age 53.6 (12.6) years, disease duration 6.3 (8.0) years) were interviewed at baseline and again after 6 months treatment with a disease-modifying antirheumatic drug (DMARD), applying the ICF Core Set for RA with qualifiers for problems on a modified three-point scale (no problem, mild/moderate, severe/complete). Patient-reported outcomes included Modified Health Assessment Questionnaire (MHAQ) and Short-Form 36 (SF-36) health survey, and disease activity was calculated. Responsiveness was measured as change in qualifiers in ICF categories, and was also compared with change in patient-reported outcomes. Results: After 6 months of DMARD treatment, improvement by at least one qualifier was seen in 20% of patients (averaged across all ICF categories), 71% experienced no change and 9% experienced worsening symptoms. Findings were similar across the different aspects of functioning. Mainly moderate effect sizes were seen for 6-month changes in the ICF Core Set for RA, especially in patients with improved health status, with similar effect size for disease activity. The components in the ICF Core Set for RA were only weakly associated with patient-reported outcomes and disease activity. Conclusions: The ICF Core Set for RA demonstrated moderate responsiveness in this real-life setting of patients where minor changes occurred during treatment with DMARDs

Nutrition status in hospitalized patients with COPD on non-invasive ventilation

Background: Nutrition is an important aspect of critically ill hospitalized patient care but the lack of consistent nutritional guidelines for sub-critically ill patients with Chronic Obstructive Pulmonary Disease (COPD) requiring non-invasive positive pressure ventilation (NPPV) may be putting vulnerable patients at risk. Hand grip strength measurements are an emerging metric for nutritional status. Objective: The objective of this study is to determine if hospitalized patients with COPD on NPPV show a difference in handgrip strength as a marker of nutritional status than those hospitalized patients with COPD not requiring NPPV. Methods: This was a prospective observational study of 10 hospitalized patients not requiring NPPV (Group 1) and 5 hospitalized patients requiring NPPV (Group 2). 3 measurements of handgrip strength on the patient’s dominate hand were averaged every alternating day during hospitalization. Mineral status and physiological parameters were also recorded concurrently with handgrip strength collection. Results: The two groups were similar overall. Group 2 had a longer length of stay, averaging 5.2 (±0.45) days, with group 1 averaging 3.2 (±0.63) days (p=0.001). Mineral status and physiological parameters between the groups were similar. Group 1 had an average change in handgrip strength of 1.59 (±1.82) kg with group 2 having an average change of -1.08 (±1.22) kg (p=0.016). Conclusion: Hospitalized patients with COPD on NPPV may be at risk for a decline in nutritional status compared to those not requiring NPPV as shown by a significant difference in change in handgrip strength

Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis

Introduction The primary objectives were to explore the associations between a comprehensive ultrasonographic (US) assessment of joints, tendons and bursae and previously described reduced joint counts (7-, 12-, 28- and 44-joint score) as well as to assess the sensitivity to change of these different US joint combinations during biological treatment. Methods Twenty patients with rheumatoid arthritis (RA) were examined by US (B-mode (BM) and power Doppler (PD)) with use of a semi-quantitative (0 to 3) score of 78 joints, 36 tendons/tendon groups and two bursae (hereafter described as the 78-joint score) at baseline and 1, 3, 6 and 12 months after initiating treatment with adalimumab. BM and PD scores for the different joint combinations were generated. Results The reduced joint scores had high correlation coefficients with the 78-joint score at all examinations (range 0.79 to 0.99 for BM and 0.77 to 0.99 for PD, each P < 0.001) and sum BM and PD scores of all the different joint combinations improved significantly during follow-up (P ≤ 0.05 to 0.001). Conclusions The reduced joint combinations were highly associated to the 78-joint score. Furthermore, all the joint combinations presently explored responded well to biological treatment. This indicates that an approach focusing on few joints and tendons gives equivalent information about the inflammatory activity in RA patients as a comprehensive US examination. The optimal combination of joints and tendons for a valid, reliable and feasible US measurement should be further explored to define a US score for follow-up of RA patients on biological treatment

Hand bone loss as an outcome measure in established rheumatoid arthritis: 2-year observational study comparing cortical and total bone loss

The aim of this 2-year longitudinal observational study was to explore hand bone loss as a disease outcome measure in established rheumatoid arthritis (RA)

Is Groundwater that Is Hydrologically Connected to Navigable Waters Covered Under the CWA?: Three Theories of Coverage & Alternative Remedies for Groundwater Pollution

The EPA’s interpretation that directly connected groundwater is within the scope of the CWA’s jurisdiction has been accepted with varying degrees of success among the federal district and circuit courts. Some courts have concluded that jurisdiction over such connected groundwater is warranted because (1) the CWA’s goal is to protect navigable waters, or (2) because the EPA is entitled to some level of deference on the issue. Other courts have decided that the CWA was simply not meant to cover groundwater, citing pieces of legislative history to support that position. A majority of courts have concluded that the CWA does cover connected groundwater, but the Supreme Court has yet to rule on the issue. This Note will explore the arguments that courts on both sides of the divide have accepted in concluding that groundwater hydrologically connected to navigable waters is or is not covered, the three potential theories for finding CWA jurisdiction over connected groundwater, what scientific factors courts have used in making case-specific determinations about whether hydrologically connected groundwater is covered, and alternative remedies that may be used to regulate or control pollution to groundwater under existing regulations

Psykoanalyse og buddhisme : en sammenligning av tradisjonene med vekt på tilnærminger til selvet

De siste par tiårene har det funnet sted en økt tilnærming mellom psykoanalyse og buddhisme knyttet til tradisjonenes delte interesse for forholdet mellom selvinnsikt og psykisk helse. Men tradisjonene har svært ulike utgangspunkt og historier. Oppgavens problemstilling er om det generelle interessefellesskapet understøttes av forbindelseslinjer mellom tradisjonenes grunnleggende perspektiver og metoder – spesielt i forholdet mellom deres respektive tilnærminger til selvet. Når det gjelder spørsmålet om hva selvet er, hva selvet gjør for og med mennesket, og hvordan mennesket er tjent med å forholde seg til selvet sitt, preges forholdet av så vel berøringspunkter som brudd. Buddhismen tenker seg at selvet manipulerer subjektets opplevelser på en slik måte at mennesket ikke kan erfare virkeligheten slik den er. Siden dette innebærer unødig lidelse, ansporer buddhismen individet til å frigjøre seg fra selvet. Selv om en kan finne fjernt beslektede synspunkter hos psykoanalytikere som Sullivan og Winnicott, så er psykoanalysens oppfatning likevel at et sammenhengende og samtidig fleksibelt selv representerer en dyptgripende og gunstig tilpasning – selvet verken kan eller bør avvikles; det bør utvikles. Nyere psykoanalytiske bidrag har imidlertid nedtonet uoverensstemmelsen: Tradisjonene fokuserer ikke på de samme aspektene ved selvet, men står snarere i hverandres blindsoner. Der det er konflikt, som i spørsmålet om subjektet kan og bør frigjøre seg fra sine selvrepresentasjoner, er det samtidig klart at en slik frigjøring bare kan skje med støtte i funksjoner som psykoanalysen nettopp tilskriver selvet. Avslutningsvis undersøkes også tradisjonenes tilnærminger til selvet med utgangspunkt i terapisituasjonen. Jeg drøfter om buddhismens selvløshet kan tas inn i den terapeutiske relasjonen uten at den terapeutiske posisjonen utfordres radikalt

Revmatoid artritt

International audienceNote sous Cour de cassation (crim.), 3 février 2016, n° 14-83.427 (FS-D), Yvan X…, Vincent X…, Stephane Y…, Steven Z…, Patrice A…, Sylvie A

Psychometric performance of the PAncreatic CAncer disease impact (PACADI) score.

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