Prevalence, incidence, mortality, and healthcare resource use for generalised pustular psoriasis, palmoplantar pustulosis, and plaque psoriasis in England: a population-based cohort study.

BACKGROUND: Generalised pustular psoriasis (GPP) and palmoplantar pustulosis (PPP) are chronic, inflammatory skin conditions. Accumulating evidence shows that GPP and PPP have different characteristics compared with plaque psoriasis and are distinct clinical entities. OBJECTIVES: To assess the epidemiology, comorbidities, mortality and healthcare use for patients with GPP and PPP compared with those with plaque psoriasis in England. METHODS: A cohort study involving analyses of longitudinal electronic health record data in the Clinical Practice Research Datalink Aurum database and linked hospital and mortality data between 2008 and 2019. The primary study outcome was the incidence and prevalence rates for GPP, PPP and plaque psoriasis in England. Secondary outcomes included survival rates and healthcare resource use (HCRU) by disease type. RESULTS: We identified 373 patients with GPP, 1,828 with PPP and 224,223 with plaque psoriasis. The mean age was 55.9 years (standard deviation [SD]: 18.6) for patients with GPP, 51.5 years (SD: 16.4) for those with PPP, and 48.5 years (SD: 19.1) for those with plaque psoriasis; 62.5% and 65.9% of patients with GPP and PPP, respectively, were women, compared with 49.4% of those with plaque psoriasis. About half of the patients were overweight or obese at baseline (GPP, 48.6%; PPP, 56.0%; and plaque psoriasis, 45.9%). The incidence rates for GPP, PPP and plaque psoriasis were 0.25 (95% CI: 0.21-0.28), 2.01 (95% CI: 1.92-2.11) and 103.2 (95% CI: 102.5-103.9) per 100,000 person-years, respectively. From 2008 to 2019, the prevalence rates per 100,000 persons ranged from 1.61 to 3.0 for GPP, 1.1 to 18.7 for PPP and 1771.0 to 1903.8 for plaque psoriasis. Survival rates were lower for patients with GPP, particularly those who were over 55 years old and those with a history of ≥1 comorbidity in each cohort. HCRU was lower in the plaque psoriasis cohort and highest in the GPP cohort, particularly among those who had ≥1 GPP flare. CONCLUSIONS: Our results provide further evidence that GPP is a distinct disease with different epidemiology, lower survival and higher HCRU than plaque psoriasis in England.

A cross-sectional comparison of prevalent diagnoses and medication profiles for residents in an assisted living facility at two time periods.

OBJECTIVES: Describe the prevalence of diagnoses and prescribed medications in an assisted living facility for one month in 2001 and 2004. DESIGN: A descriptive, cross-sectional report. SETTING: An assisted living facility in Seattle, Washington. PARTICIPANTS: Assisted living facility residents. INTERVENTIONS: In March 2001 and January 2004, charts of all the assisted living facility residents were reviewed. Cross-sectional comparisons of demographics, total and average numbers of charted diagnoses, and prescribed medications were conducted. Prevalent diagnoses and medications used were identified. Among the residents present in both periods, longitudinal comparisons of treatment outcomes for hypertension (HTN) and diabetes mellitus (DM) were assessed. MAIN OUTCOME MEASURES: Changes in demographics, diagnoses, medications, and blood pressure and blood glucose readings. RESULTS: Charts of 52 (2001) and 54 (2004) residents were reviewed. HTN, DM, and gastrointestinal (GI) disease were the most prevalent diagnoses during both time periods, although the prescribed medications for these conditions were different in 2001 and 2004. The per-resident numbers of diagnoses and medications averaged 7.2 +/- 3.3 and 9.1 +/- 4.7, respectively, in 2004, compared with 5.1 +/- 1.9 and 6.4 +/- 3.6 in 2001. Among 11 residents who lived in the assisted living facility during both data-collection months, the per-resident averages were 5.2 +/- 2.2 diagnoses and 8 +/- 3.9 medications in 2001, compared with 7.9 +/- 2.9 and 11.1 +/- 5.1, respectively, in 2004. The average blood pressure readings among these residents improved in 2004 over those in 2001, though no improvement was seen in the average blood glucose readings. CONCLUSION: To address the changing needs of assisted living facility residents over time, active ongoing monitoring and assessment of residents' medication therapies by pharmacists are indicated.

The Brief Fatigue Inventory is reliable and valid for the burn patient cohort.

OBJECTIVE: After burn, patients are at risk of fatigue which may influence negatively their capacity to participate in activity, rehabilitation and other treatments. Fatigue may stem from the wound healing and systemic responses to burn which drive a hypermetabolic state that may persist for months. However, an established method is not available for objectively measuring fatigue after burns. The Brief Fatigue Inventory (BFI) was hypothesised to be an appropriate option for assessments following severe burn. The primary aim of the study was to establish if the BFI was reliable and valid in a burn patient sample. METHODS: Adult patients admitted between 2009 and 2013 to Royal Perth Hospital Burn Center were included. Patients completed the BFI and Burns Specific Health Scale Brief (BSHS-B) in tandem at one, three, six and 12 months after burn. Reliability was assessed using Cronbach's alpha; construct validity using factor analysis and multi-variable regression of BFI; and, criterion validity with longitudinal regression of BFI with BSHS-B. RESULTS: The sample (n=587) had a median TBSA of 3% (range=<1-75%). The BFI demonstrated excellent reliability (α>0.90). The factor analysis confirmed a single-domain construct, centred around the first scale item. Good correlation between BFI and BSHS-B scores (p<0.001) on longitudinal analysis confirmed criterion validity. There was a significant difference in fatigue scores between minor and major burn patients and a significant association of fatigue levels over time with TBSA. CONCLUSION: The BFI is a reliable and valid tool for fatigue measurement in patients during the first 12 months after burn.

SAR Development of Lysine-Based Irreversible Inhibitors of Transglutaminase 2 for Huntington's Disease.

We report a series of irreversible transglutaminase 2 inhibitors starting from a known lysine dipeptide bearing an acrylamide warhead. We established new SARs resulting in compounds demonstrating improved potency and better physical and calculated properties. Transglutaminase selectivity profiling and in vitro ADME properties of selected compounds are also reported.

Irreversible 4-Aminopiperidine Transglutaminase 2 Inhibitors for Huntington's Disease.

A new series of potent TG2 inhibitors are reported that employ a 4-aminopiperidine core bearing an acrylamide warhead. We establish the structure-activity relationship of this new series and report on the transglutaminase selectivity and in vitro ADME properties of selected compounds. We demonstrate that the compounds do not conjugate glutathione in an in vitro setting and have superior plasma stability over our previous series.

Pharmacist provision of language-appropriate education for Asian patients with asthma.

OBJECTIVE: To improve asthma treatment outcomes in Asians living in Seattle and for whom English is a second language. DESIGN: Pre-post design. SETTING: International Community Health Services, Seattle, Washington. PATIENTS: Asians older than 18 years with asthma and whose native language was not English. INTERVENTION: Pharmacists or pharmacy students provided oral and written asthma education in the subject's native language. MAIN OUTCOME MEASURES: Self-reported use of valve-holding chambers and peak flow meters; self-reported asthma symptoms at baseline and 6 months after intervention; number of acute asthma-related (non-routine, non-follow-up) clinic visits during the 6 months before and after the intervention. RESULTS: Thirty-two subjects, aged 42 to 88 years, participated. Subjects demonstrated a reduction in mean number of asthma attacks (3.7 to 1.0, P < .001) and night awakenings (1.4 to 0.3, P < .001). Patient satisfaction with the program was excellent. Spacer and peak flow meter use increased from 7 to 18 subjects (P < .001) and 1 to 14 subjects (P < .0002), respectively. CONCLUSION: Language-appropriate asthma education improved treatment outcome for patients whose native language was not English.