Efficacy,Safety, and Out-of-pocket Costs are the Most Important Factors to Patients in Choosing a Psoriasis Therapy

Objective: To determine which factors (i.e., cost, efficacy, safety, and method of delivery) influence choice of psoriasis treatment by patients and how patients obtain information regarding treatment options. Design: Anonymous survey. Setting: Specialty Psoriasis Clinic at an academic dermatology department over a six-month period. Participants: Convenience sample of 40 psoriasis patients. Measurements: Participant demographics, psoriasis treatment history, sources of information about treatment options, factors influencing treatment choices, and knowledge of treatment costs. Results: The mean (±SD) patient age and duration of psoriasis was 50 (±17) and 19 (±17) years, respectively. Factors influencing patient’s choice of psoriasis treatment were, in order of importance: efficacy (90% very important), safety/side effects (65%), patient’s own cost (53%), then total treatment cost (46%), frequency of use (37%), and method of medication delivery (i.e., topical, oral, or injection; 17%). Eighty percent of patients reported not knowing the total cost of any psoriasis treatments. The patient’s dermatologist was identified as both the most important (90%) and the most influential (75%) source of information for selecting psoriasis treatments, with the internet being the second most important source. Conclusion: Patients, in large measure, are unaware of the costs for different psoriasis treatments. Efficacy, safety, and out-of-pocket costs are the most important factors to patients in deciding on a psoriasis treatment.Psoriasis is a chronic inflammatory disease with significant impact on quality of life. Biologic therapies, although expensive, may reduce disease burden.1,2 One study exploring factors influencing dermatologists’ psoriasis treatment decisions reported that side effect profile, then medication cost, were the most important treatment-specific factors influencing their choice of psoriasis therapies.3 However, there are little data on which factors influence treatment decisions from the patients’ perspective and how patients obtain information about medications to participate in the decision-making process. The authors developed a survey to explore these factors.     

Efficacy of Corticosteroids on Postoperative Endodontic Pain: A Systematic Review and Meta-analysis

Introduction

The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of corticosteroids on postoperative endodontic pain and to determine/adjust between-trial heterogeneity using meta-regression analysis.

BCGiosis as a presenting feature of a child with chronic granulomatous disease

Bacillus Calmette Guerin (BCG) vaccine, which is administered to all newborns in some regions, could lead to serious complication ranging from local disease (known as BCGitis) to disseminated disease (BCGosis) in a group of patients with primary immunodeficiency diseases. We are reporting here a 3.5 year-old girl with a history of prolonged BCGitis, which developed to disseminated disease without any other special features. Immunological studies with nitro-blue tetrazolium test confirmed the diagnosis of chronic granulomatous disease in this patient. Chronic granulomatous disease should be considered in the list of differential diagnosis in all children with BCGosis, even in the absence of any other manifestations related to immunodeficiency.     

Upper Endoscopic Findings in Children with Recurrent Abdominal Pain: High Prevalence of Hiatus Hernia

Objective

Recurrent abdominal pain (RAP) by itself is one of the common reasons in child-aged patients to refer to a clinician. Some of these patients are presented with more serious features, so-called the “red flag”. The most important issue in management of RAP is to distinguish the type of it, whether it is functional or organic. In this study we aimed to assess the redundancy of red-flagged RAP with findings of esophago-gastro-deudonoscopy.

Methods

In a 2 year prospective study 150 consecutive children with RAP who showed red flags underwent esophago-gastro-deudonoscopy. The prevalence of each finding was recorded. Overall positive predictive value of predicting an endoscopic finding while having a red-flag was calculated.

Findings

Among all the patients, 126 cases showed at least a positive finding in their endoscopy that corresponded to the positive predictive value of 84% for predicting the presence of an endoscopic finding according to red flags. Interestingly, 20% of patients showed hiatus hernia when surveyed.

Conclusion

Comprehensive physical examination is needed to avoid performing esophago-gastro-deudonoscopy without indication in patients with recurrent abdominal pain.