The Infliximab Multinational Psoriatic Arthritis Controlled Trial (IMPACT): results of radiographic analyses after 1 year

OBJECTIVE: Infliximab is effective in improving signs and symptoms of joint/skin involvement, functional status, and quality of life in patients with psoriatic arthritis (PsA). Using IMPACT trial data, we assessed the effect of infliximab (IFX) on structural damage in PsA. METHODS: Patients with active PsA were randomly assigned to receive placebo (PBO/IFX) or infliximab 5 mg/kg (IFX/IFX) at weeks 0, 2, 6, and 14, with the primary endpoint at week 16. The PBO group received infliximab loading doses at weeks 16, 18, and 22. Thereafter, all patients received infliximab 5 mg/kg every 8 weeks through week 50. Hand/feet radiographs were obtained at weeks 0 and 50. Total radiographic scores were determined using the PsA modified van der Heijde-Sharp (vdH-S) score. Projected annual rate of progression was calculated by dividing x ray score by disease duration (years). RESULTS: As reported previously, 65% of infliximab treated patients versus 10% of PBO treated patients achieved an ACR20 response at week 16 (p<0.001). At week 50, 69% of patients achieved an ACR20 response. Radiographs (baseline and week 50) were available for 72/104 patients. At baseline, estimated mean annual rate of progression was 5.8 modified vdH-S points/year. Mean (median) changes from baseline to week 50 in the total modified vdH-S score were -1.95 (-0.50) for PBO/IFX and -1.52 (-0.50) for IFX/IFX patients (p = NS). At week 50, 85% and 84% of patients in the PBO/IFX and IFX/IFX groups had no worsening in the total modified vdH-S score. CONCLUSION: Infliximab inhibits radiographic progression in patients with PsA through week 50.     

The effectiveness of a training for patients with unexplained physical symptoms: protocol of a cognitive behavioral group training and randomized controlled trial

Background  

In primary care, up to 74% of physical symptoms is classified as unexplained. These symptoms can cause high levels of distress and healthcare utilization. Cognitive behavioral therapy has shown to be effective, but does not seem to be attractive to patients. An exception herein is a therapy based on the consequences model, which distinguishes itself by its labeling of psychosocial distress in terms of consequences rather than as causes of physical symptoms. In secondary care, 81% of the patients accepts this therapy, but in primary care the outcome is poor. We assume that positive outcome can also be reached in primary care, when the consequences model is modified and used bottom-up in an easily accessible group training, in which patients are relieved of being blamed for their symptoms. Our aim is to investigate the (cost-)effectiveness of this training.     

Callous-unemotional behaviors in young girls: shared and unique effects relative to conduct problems.

Among girls, little is known about the shared and unique associations that callous-unemotional (CU) behaviors and conduct problems have with aspects of emotional and behavioral dysregulation and with parenting practices. This study examined these associations using a large community-based sample of young girls (N = 990). The findings revealed that hyperactivity-impulsivity and negative emotionality were positively and uniquely associated with conduct problems, but not with CU behaviors, after controlling for co-occurring conduct problems. Conduct problems were also positively associated with both generalized anxiety and panic/somatic anxiety. In contrast, CU behaviors were negatively related to generalized anxiety problems after controlling for co-occurring conduct problems. The results also indicated that conduct problems were more closely associated with harsh punishment and low parental warmth among girls with low versus high CU behaviors.     

Unsuspected transection of lung by pigtail catheter in a premature infant.

Thoracostomy tubes are commonly required to treat pnuemothoraces in premature infants. Evidence of impalement of the lungs by tube thoracostomy has been seen in autopsy studies. In neonates, there has been described a surprisingly high incidence of lung perforation. The premature lung is thought to be at greater risk for this complication owing to the pliant, thin chest wall, the proximity of vital tissues and the fragility of the lung tissue itself. The modified Fuhrman catheter, or polyurethane pigtail catheter, has been developed for the drainage of pneumothorax in premature infants. In a study of complications of the placement of pigtail catheters, no instance of penetration of the lungs was reported. We report the case of a premature infant with pigtail catheter placement that, at autopsy, was found to have impaled the lung and discuss the incidence of lung injury associated with invasive management of pnuemothoraces.     

The good behaviour game

The aim of this study was to reduce disruptive behaviour among a group of boys with 'behaviour problems' using the 'Good Behaviour Game'. The procedure involved dividing the class into two teams, setting a 'winning' criteria for a decrease in the rate of disruptive behaviour and providing consequences for a response rate less than the 'winning' criteria or less than the other team's response rate. Reinforcement was in the form of a variety of confectionery and stationery items. A baseline period measured the frequency of two target behaviours, talking and out-of-seat behaviour, across five sessions. The intervention phase consisted of six sessions with the 'winning' criteria set at ten disruptions per lesson or less and a further three sessions with the 'winning' criteria set at five disruptions per lesson or less. The results showed a marked decrease in the observed rates of the two target behaviours on implementation of the intervention phase. Further reductions were observed when the 'winning' criterion was lowered. These results support the findings of previous research by demonstrating the effectiveness of the Good Behaviour Game with 'behaviouraity disturbed' children.