Long‐term efalizumab therapy for patients with moderate‐to‐severe,chronic plaque psoriasis: results from an Australian expanded access program

Background Psoriasis is a chronic skin disease that can impact heavily on a patient’s well‐being. Efalizumab, a unique, targeted, biological therapy, has demonstrated efficacy in treating moderate‐to‐severe, chronic plaque psoriasis with ≤36 months of continuous therapy. The objective of this Extended Access Program (EAP) was to evaluate further the benefit of efalizumab as long‐term therapy in a real‐world clinical setting. Methods After an initial conditioning dose of efalizumab (0.7 mg/kg subcutaneously), a weekly dose of efalizumab (1.0 mg/kg) was administered for ≤21 months. Patients with reduced Psoriasis Area and Severity Index (PASI) scores (≥50%, or a score ≤8) at month 3 entered the long‐term maintenance treatment period. Results In total, 101 patients (>18 years) with severe plaque psoriasis enrolled on the EAP, of these 93 (92.1%) met all the inclusion criteria. After 3 months of treatment, 84/101 (83.2%) patients had evaluable data and entered the maintenance period. After 3 months, 57/84 (67.9%) patients had achieved PASI‐50. Using an intent‐to‐treat analysis, after 21 months of treatment, PASI‐75 and PASI‐50 were achieved by 43/101 (42.6%) and 69/101 (68.3%) of patients, respectively. Efalizumab was generally well tolerated during the 21 months of continuous therapy. Conclusion Efalizumab, 1.0 mg/kg/week, is effective and well tolerated in a ‘real world’ clinical setting, providing enduring reduction of psoriasis symptoms for up to 21 months.     

Randomized Controlled Trial of a Computer Strategy to Increase General Practitioner Preventive Care

Background. Previous interventions targeting primary care practitioners with the aim of increasing preventive care delivery have demonstrated limited effectiveness. The primary aim of this study was to assess the effectiveness of a computerized continuing medical education program to increase rates of three screening behaviors (cholesterol, blood pressure, and cervical screening) and to identify three risk behaviors (smoking, alcohol consumption, benzodiazepine use) in general practice.Methods. Nineteen general practitioners were randomly allocated to intervention or control conditions. Those given the intervention received a computerized feedback system. The intervention was delivered using a touchscreen computer located in the surgery waiting area. The preventive behaviors of interest were patient smoking, alcohol use, benzodiazepine use, and blood pressure, cholesterol and cervical screening using the Papanicolou test. Differences in performance by group in each of the outcomes was measured at baseline and 3-month follow-up. Logistic regression analyses with generalized estimating equations were conducted as the main analyses.Result. At 3-month follow-up, statistically significant differences were evident in the following outcome measures: accurate classification of benzodiazepine users (z = 2.8540, P < 0.05); accurate classification of non-benzodiazepine users (z = 2.7339, P < 0.05); accurate classification of hazardous or harmful alcohol drinkers (z = 2.3079, P < 0.02); blood pressure screening (z = 3.4136, P < 0.001); and cholesterol screening (z = 6.6313, P < 0.001).Conclusion. A computerized system of performance-specific feedback was effective at increasing some preventive care services in general practice.     

Gastroesophageal Reflux in Obesity: The Effect of Lap-Band Placement

Background: Gastroesophageal reflux disease (GERD) is a common condition which is often aggravated by morbid obesity. Lap-Band surgery provides effective weight loss in the morbidly obese. There have been several reports that gastric banding causes or aggravates reflux. The aim of this study was to evaluate the effect of Lap-Band placement on GERD. Methods: All patients with a significant history of GERD who had a Lap-Band inserted over a 2-year period were evaluated postoperatively to assess any change in impact on reflux. Resolution required absence of reflux symptoms and no anti-reflux drug therapy. Results: There were 48 (16%) of 274 consecutive patients with a significant history of reflux esophagitis requiring regular therapy preoperatively. The median age was 39 (range 23-58) and M:F ratio was 5:43. We confirm a high prevalence of GERD in patients with morbid obesity: 17% with symptoms requiring regular therapy (Community Norm 7%). Total resolution of all reflux symptoms occurred in 36 (76%) patients, improvement in 7 (14%), no change in 3 (6%), and aggravation of symptoms in 2 (4%). Patients with severe and moderate symptoms had similar improvement. Resolution or improvement was reported soon after surgery. Conclusion: Rapid and major improvement in symptoms of GERD occurs after Lap-Band placement. The placement of the band probably acts directly to reduce reflux. This result contrasts with reports which have found gastric banding causes or aggravates GERD.     

Pubertal development and primary amenorrhoea

Puberty is the physical, emotional and sexual transition from childhood to adulthood. It involves five changes: breast, pubic hair, axillary hair development, the growth spurt and the onset of menstruation. In girls, pubertal development commences at around 8-9 years of age and lasts for 4-5 years. This review looks at the investigation into the absence of periods (primary amenorrhoea) if there is a failure to establish menstruation by the age of 14 years in girls without signs of secondary sexual development or by the age of 16 in the presence of normal secondary sexual characteristics. Primary amenorrhoea can be classified according to the presence or absence of secondary sexual characteristics. The onset of menstruation should usually occur within 2 years of the onset of breast development, pubic and axillary hair development and the growth spurt.     

Retraining Visual Processing Skills To Improve Driving Ability After Stroke

Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke.

Objective

To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke.

Design

Randomized controlled trial.

Setting

Outpatient rehabilitation clinic in Australia.

Participants

People with stroke (N=26) referred for driving assessment.

Interventions

Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist.

Main Outcome Measures

The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment.

Results

No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, and self-efficacy.

Conclusions

In this small trial, training underlying skills (such as executing a continuous wide scan, combining motor and visual processing into a motor response) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes. Larger trials are needed to evaluate devices that claim to retrain underlying skills related to driving.