Inpatient management of psoriasis: a multicentre service review to establish national admission standards.

BACKGROUND: Some patients with psoriasis may require hospital admission to stabilize their condition, although the role of inpatient management is changing given recent advances in therapeutic options, emphasis on community-based care for chronic conditions and limited healthcare resources. There is a need for evidence-based national standards for inpatient management of psoriasis taking account of factors that predict length of stay. OBJECTIVES: To determine which factors predict length of stay for patients with psoriasis requiring inpatient hospital care with a view to setting evidence-based standards for inpatient psoriasis management. METHODS: A multicentre service review was conducted on all psoriasis admissions over a 9-month period in four dermatology centres in the U.K. We collected data on admission, at discharge and, where possible, at 3 months following discharge. Psoriasis severity was assessed using four validated scoring systems, including Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index. We also recorded length of stay and treatment details. RESULTS: Length of stay varied widely between the four centres, but was similar in the two centres which received a high proportion of tertiary referrals for severe psoriasis (mean 19.7 days, range 1-78, analysis of variance P=0.002). Disease severity, measured by PASI, on admission (mean 15.7, interquartile range 8.3-20.8) was significantly higher in the tertiary centres (P<0.0001). However, there was no significant difference in PASI between centres on discharge. The admission PASI was significantly associated with length of stay (r=0.2, P=0.02). There was no significant correlation between other measures of disease severity and length of stay. CONCLUSIONS: Disease severity on admission for patients with psoriasis is greater in tertiary referral centres for psoriasis and is directly associated with length of stay. Length of stay should be used in conjunction with clinical measures such as PASI improvement to set national standards for quality in secondary care.

The Dermatology Life Quality Index: assessing the efficacy of biological therapies for psoriasis.

BACKGROUND: Clinical trials show improvement in physical and health-related quality of life (HRQoL) measures in patients with psoriasis treated with biologics compared with placebo. However, these reports only give limited interpretation of the meaning of Dermatology Life Quality Index (DLQI) scores and provide limited comparison data. OBJECTIVES: The aim of this paper is to identify which biological therapy provides the greatest improvement in HRQoL following treatment of patients with chronic plaque psoriasis, as assessed by the DLQI. METHODS: We reviewed all data published up to August 2006 of randomized placebo-controlled trials (RCTs) of the four biologics currently licensed in some countries for clinical use in chronic plaque psoriasis (alefacept, efalizumab, etanercept and infliximab) which have used the DLQI as an outcome measure. The DLQI data were assessed based on overall improvement according to the DLQI descriptor bands and on clinically meaningful improvement of > or = 5. RESULTS: Fifteen peer-reviewed articles and 59 abstracts describing 11 multicentre, double-blind RCTs were reviewed. Treatment with any one of the four biologics led to a clinically meaningful improvement in the DLQI of > or = 5. However, when applying the DLQI banding concept, infliximab and etanercept provided the greatest improvement in the overall HRQoL from a 'very large effect on overall HRQoL' at baseline to 'a small effect on overall HRQoL' following treatment. CONCLUSIONS: The DLQI banding concept provides a further tool to assess the impact of biologics on HRQoL of patients with psoriasis. Based on retrospective application of DLQI bands to published RCT data, infliximab, followed by etanercept, showed the greatest improvement in the overall HRQoL paralleled by a 75% improvement in the Psoriasis Area and Severity Index. However, some publications did not provide absolute baseline DLQI values, making interpretation of data and comparison between the agents difficult. Side-to-side comparative studies between biologics and between biologics and nonbiological psoriasis treatments will aid evidence-based psoriasis management decisions in the future.

Patterns of eating and movement that best maintain reduction in overweight.

Two studies of the influences of specific patterns of eating and exercising behaviour on body weight in English Midlands women were re-analysed using correlations as the measure of effect size. As predicted from computational modelling of hunger-sating mechanisms, avoiding energy-containing drinks and foods at the ends of and between meals was the behaviour most influencing year-long weight loss. However, although eating between meals is often called snacking, the term 'snack' appeared to be too ambiguous in this culture for its use in helping efforts to control weight. Avoidance of particular sorts of fat-rich foods was also associated with longer-term weight loss. Attempts at severe restriction of intake at mealtimes were associated with weight loss during a period of intensive dieting, but did not contribute to maintenance of that weight reduction. Using diet formulae to attain rapid weight loss was associated with significant weight gain over a year. These results support the suggestion that the first line of defence against weight gain is avoiding all sources of energy during drink breaks, with personally relevant advice on lower fat versions of particular foods also being important. Continued neglect of the behaviour-specific correlational approach to gaining evidence for less fattening habits does nothing to slow the rise in obesity.

Rosacea fulminans in pregnancy.

Rosacea fulminans is a rare condition with a female preponderance and unknown aetiology, characterized by the abrupt onset of papules, pustules and erythema affecting the face. Corticosteroids and isotretinoin are regarded as the two main therapeutic agents. We report a case associated with pregnancy, and discuss the therapeutic implications. This is the first published report of rosacea fulminans in pregnancy complicated by stillbirth.

Does emotional eating interfere with success in attempts at weight control?

Questionnaire responses from a convenience sample were used to test for hypothesized relationships between changes over time in individuals' reported frequency of emotional eating and estimates of their success in attempts to reduce body weight over periods of at least 1 year. Respondents were 187 English adults, whose distribution of estimated Body Mass Indices (BMI) approximately that of the general population. Initial BMI was significantly (p less than 0.001) positively associated with reported frequency of emotional eating. Moreover, respondents indicating initially relatively high levels of emotional eating who reported a reduction in that level were found to lose significantly (p less than 0.01) more reported weight and to be significantly (p less than 0.05) more successful at approaching target weight over the period of the study than respondents who continued to report high levels of emotional eating. Similarly, respondents who reported an increase from initially relatively low levels of emotional eating, while not losing significantly less reported weight, were significantly (p less than 0.05) less successful at approaching target weight than those respondents who continued to report low levels of emotional eating.

Infection of Syrian hamsters with lymphocytic choriomeningitis virus: comparison of detection methods.

The prevention of hamster-associated outbreaks of lymphocytic choriomeningitis virus infection in human beings requires rapid and reliable testing of large numbers of hamsters for the infection. To select the most effective test, the antibody response of infected hamsters was determined by the indirect fluorescent antibody and complement-fixation techniques. The indirect fluorescent antibody technique required less than 2 hours to complete, was the first to become positive after infection, and remained positive for at least several months. Infection in hamsters was also readily detected by the inoculation of mice with infected hamster tissues; virus could be isolated from several organs as early as postinoculation day (PID) 3, and all organs tested contained high concentrations of virus by PID 5. After PID 40, virus was detectable only in the kidney; this organ remained positive for over 3 months.

Serological diagnosis in children infected prenatally with lymphocytic choriomeningitis virus.

Lymphocytic choriomeningitis virus antibody was detected by immunofluorescence in sera collected 2 to 8 years after birth from six children probably infected prenatally. A neutralization test failed to detect antibodies in two of these children.

A rapid fluorescent focus-inhibition test for determining dengue neutralizing antibody and for identifying prototype dengue viruses.

Neutralizing antibody to dengue virus in human and animal sera was assayed by the rapid fluorescent focus-inhibition test (RFFIT). Neutralizing-antibody titers could be detected after only 24 h compared to 5--6 days required by the plaque-reduction test. The RFFIT is more definitive than the conventional complement fixation (CF) or hemagglutination-inhibition (HI) test in identifying prototype dengue viruses, is reproducible, and is applicable to the routine detection of neutralizing antibodies to dengue viruses.