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. Int J Environ Res Public Health. It does not provide a predefined or limited list of disease manifestations or organ systems, thus allowing one to capture all the heterogeneous aspects of SLE disease activity. Oxford University Press is a department of the University of Oxford. Content validity was reported in 89 studies. AU - Louthrenoo, Worawit. This button displays the currently selected search type. The aim of this systematic literature review is to describe and analyse the . , Francis S (PGA), physician global assessment of disease activity (PHGA), C3, C4, and Anti-ds . PGA is a valid, responsive and feasible instrument, though its reliability was impacted by the scale adopted, suggesting the major need for standardization of its scoring. Criterion validity also refers to the degree to which an instrument predicts aspects and phenomena occurring in the future [108]. Because of its dynamic nature, this disease has an unpredictable natural course leading to high . The pooled correlation coefficient (95% CI) is given both for the fixed effects model and the random effects model. The judgment of whether a patient with SLE has active disease is a central question both in routine patient management and in clinical research [4]. This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. , Lau CS Whenever papers reported duplicate data, the most recent article was selected. Bookshelf Strength. SLE3. Navarra SV , Gallacher AE Three studies evaluated the association between PGA scores and treatment changes: PGA correlated negatively with adherence to treatment assessed through an item scale (r=0.31, P=0.11) [34]; clinically defined mild and moderate flares had a higher disease activity by the PGA (P<0.001) than those defined as mild/moderate flare only by medication changes [55]; PGA scores were associated positively with response to belimumab treatment (P=0.039) [43]. Unauthorized use of these marks is strictly prohibited. According to the OMERACT, face validity is the degree to which the instrument appears to match with the target domain, according to experts [18]. Prinsen CAC The aim of this systematic review is to describe and analyse the measurement properties of the PGA, including the validity, reliability, responsiveness and feasibility. In a post-hoc analysis of phase 3 belimumab trials, improvements and no worsening in the PGA were greater among SRI responders vs SRI non-responders (P<0.001) [52]. , Jolly M. Mazur-Nicorici L PGA0.3. 2022 Sep;8(2):e002395. Manzi S global automatic chemiluminescence immunoassay analyzer market INTRODUCTION The chemiluminescence immunoassay system employs magnetic particle separation technology, which employs magnetic particles as antibody carriers and allows for even distribution of the carriers in the liquid phase reaction system, resulting in a faster and more effective . Before , Ibanez D The PGA is usually reported by experts as allowing exhaustive coverage of the concept of disease activity in SLE [20, 108]. Objective Physician's global assessment (PGA) of disease activity is a major determinant of therapeutic decision making. Five studies have demonstrated good ICC values for reliability (all >0.60 and ranging up to 0.97). Kiani AN Elisabetta Chessa, Matteo Piga, Alberto Floris, Herv Devilliers, Alberto Cauli, Laurent Arnaud, Use of Physician Global Assessment in systemic lupus erythematosus: a systematic review of its psychometric properties, Rheumatology, Volume 59, Issue 12, December 2020, Pages 36223632, https://doi.org/10.1093/rheumatology/keaa383. Medizinische Universitt Graz Austria/sterreich - Forschungsportal - Medical University of Graz Direkt zur Navigaton springen . Thanks to this feature, the PGA was included in composite indices with the aim of rating manifestations not included in glossary-based instruments such as the SLEDAI and BILAG [3] or for which a threshold has been defined (cytopenia). , Sengupta M , Sadovici-Bobeica V (PGA)and physician global assessment of disease activity (PHGA), C3, C4 and Anti-ds Anti-DNA titer abnormalities, and a formula incorporating the current . , Perez-Gutthann S Objective: To examine the feasibility of using Physician Global Assessment (PGA) scores to collect and track patient acne and . Nevertheless, despite the fact that the PGA was considered the reference in 39 studies involving other indices, it was used as the sole instrument in only 2 of them. Devilliers H , Gordon C Content validity pertains to the degree to which the instrument measures all facets of a construct of interest [20]: this property is satisfied if the PGA is considered able to measure all aspects of disease activity in SLE in a comprehensive way. et al. Parodis I Thus the development of a comprehensive index for assessing disease activity still represents one of the most important challenges in SLE [7]. Correlations with other instruments measuring similar constructs should typically demonstrate a coefficient (r) 0.50 [106]. et al. , Schirmbeck LA Petri M , Petri MA Jiao H, Acar G, Robinson GA, Ciurtin C, Jury EC, Kalea AZ. , Saad-Magalhes C In one open-label study [43], the decrease in PGA score was considered the primary endpoint. This property is reported across all articles selected through this systematic review [24, 913, 21103]. Despite the need for new treatments in CLE . , Trendelenburg M However, it was used as a single outcome measure only in two studies [49, 100], while in the majority the PGA was scored together with another instrument (typically the SLEDAI) [2, 9, 11, 12, 21, 24, 30, 32, 34, 3740, 44, 45, 48, 49, 55, 58, 59, 61, 63, 64, 66, 67, 74, 75, 80, 82, 86, 8995, 103]. Ward et al. Uribe AG, Vil LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcn GS. SLE or at an SLE site, but only if the injury requires treatment by a licensed medical doctor. Moreover, there is uncertainty as to whether the best timing of assessment is prior to or after reviewing laboratory exams [26]. , Andreoli L Brunner HI Identification of new candidate drugs for primary Sjgrens syndrome using a drug repurposing transcriptomic approach, When it looks like Behets syndrome but is something else: Differential diagnosis of Behcets syndrome: a two-centre retrospective analysis, Huge water-balloons in the belly: multiple pancreatic pseudocysts in systemic lupus erythematosus, A randomized, double-blind, placebo-controlled, parallel group study on the effects of a cathepsin S inhibitor in primary Sjgrens syndrome, How to plug the leaky pipeline in clinical rheumatology across Europelessons to be learned from experiences in business, About the British Society for Rheumatology, British Society for Rheumatology Journals, https://doi.org/10.1093/rheumatology/keaa383, https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 British Society for Rheumatology. et al. Published by Oxford University Press on behalf of the British Society for Rheumatology. One study showed a significant ability of the PGA in distinguishing between patients (P<0.0001) and observers (P<0.0001), but not between visits [79]. Mina R They participate in physiologic and inflammatory cascades and have become a major focus of research, yielding novel therapies for immune-mediated inflammatory diseases (IMID). , Cella D. van Vollenhoven RF , Mokkink LB It is unclear when or with what justification the physician global assessment of disease status (PhGA) was first used to assess patients with systemic . BATCH RUBY INTENSIVE REVIEWRTRMF 3. , Ravelli A Compared with nonresponders, BICLA responders had greater improvements in global and organ-specific disease activity (Physician's Global Assessment, SLE Disease Activity Index 2000, Cutaneous Lupus Erythematosus Disease Area and Severity Index Activity, and joint counts; all nominal P < 0.001). , Magder L Provide oversight to Shared Services Derivatives team supporting RWA operations and production. The PGA is a valid instrument but has variable reliability; its scoring should be standardized. , Borghoff K The content can vary and relates either to global health (e . , Carpenter AB Montreal, Canada Area. Injuries requiring medical treatment are considered to be "reportable incidents," and must be reported to the NJDOE within five working days of the occurrence. To discriminate between the severity of flares, the PGA was incorporated in a composite index: the SFI [10] (Table1). et al. , Guzmn RM , ODell JR Merrill JT Please enable it to take advantage of the complete set of features! Jesus D A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [17], searching for articles reporting on the use of PGA in SLE. CareerBuilder TIP. , Ho LY Physician's Global Assessment Scale (PGA) or Investigator's Global Assessment Scale (IGA) measures disease status in a broad range of diseases. doi:10.1136/ rmdopen-2017-000578 Prepublication history and Physician global assessments for disease activity in rheumatoid arthritis are all over the map!. 'Not at target': prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study. Wells GA Liang MH Notorious to increase IOP and cause severe PAIN and headache; Diagnostics: - History - Tonometry examinations - measures IOP QUESTION A client states that the physician has told her that her intraocular was 14. Learn more. In the last 30years, more than a dozen scores have been derived to assess disease activity in SLE, but not all of these have proven to be valid and reliable tools. The company serves physicians and patients. The PISCOS results will allow for increased homogeneity and reliability of PGA ratings in routine clinical practice, definitions of remission and low disease activity, and future SLE trials. This study assesses the reliability of the PGA, measured by means of 0-100 mm visual analog scale (VAS), and the additional use of separate VAS scales for musculoskeletal (PhysMSK) and dermatologic (PhysSk) manifestations in patients with psoriatic arthritis (PsA). Of note, it is not trivial that we found a good convergent validity with other instruments (SLEDAI, BILAG, LAI, SLAM and ECLAM) [10, 23, 24, 26, 28, 29, 35, 54, 68, 76, 84, 99]. A good responsiveness for PGA was shown in eight studies. When expanded it provides a list of search options that will switch the search inputs to match the current selection. , Schur PH. Schneider M The PGA is intended to encapsulate the physician's judgement of overall disease activity.Consensus on whether the PGA should be performed prior to, or after the receipt of laboratory values is lacking. Glossary: PGA. , Farewell V RN-BSN HOLISTIC HEALTH ASSESSMENT ACROSS THE LIFESPAN (NURS 3315) Sociology of Social Problems (SOC213) Ann Rheum Dis 2011;70:54-9. , Alunno A In 1988, Liang et al. , Hambleton IR Conducting medical monitoring, safety review, narrative writing and etc.. Perform medical assessment of individual . Convergent validity is fulfilled indirectly in studies where the PGA is used as the gold standard to assess the construct validity of other indices. et al. Background/Purpose: The Physician Global Assessment (PGA) is a frequently-used outcome measure in Systemic Lupus Erythematosus (SLE). Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. et al. However, the PGA allows for the measurement of disease activity in a global way (content validity). , Anderson N , Petri MA Bethesda, MD 20894, Web Policies , Hennis A. Jesus D , Mohan C. Giangreco D No study has evaluated the feasibility of the PGA in SLE to date. Laboratory investigation results influence Physicians Global ssessment (PGA) of disease activity in SLE. et al. et al. Physician's Global Assessment (PGA) score 1.0 on a 0 to 3 visual analog scale. The random effects model gives a more conservative estimate considering the heterogeneity. It is therefore desirable to use the PGA along with other tools (typically the SLEDAI) or to include the PGA in a composite index (e.g. X 20 Physician Global Assessment 10.1136/lupus-2019-lsm.176 . [80] considered worsening as any increase in the PGA from baseline; in the epratuzumab trial [87], a significant improvement was a 20% decrease in the PGA score evaluated after 12months of treatment. et al. 2021 Apr 8;5(1):33. doi: 10.1186/s41687-021-00298-x. , Arora S This enabled the PGA to be considered the gold standard in several studies [2, 10, 11, 21, 23, 49, 67, 76, 78, 84, 88]. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. Medical-Surgical Nursing Clinical Lab (NUR1211L) U.S. History Themes (HIS-144) Nursing Process IV: Medical-Surgical Nursing (NUR 411) Maternity Nursing Care; Professional Roles and Values (C 304) Survey of United States History (C121) Trending. The responsiveness of the PGA is the ability to detect worthwhile variations in disease activity over time, measuring worsening or improvements in SLE disease status. National Library of Medicine et al. sharing sensitive information, make sure youre on a federal Measurement properties of the PGA were analysed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) terminology [19]. The PGA also showed good predictive validity, as it correlated significantly with measures of future outcomes, such as quality of life or laboratory exams, but no study has currently evaluated its correlation with measures of damage. Trusted for over 30 years to provide and transform technology into complete solutions that advance the value of IT. Ruiz-Irastorza G If you have a published paper from this period that does not appear on this list, please contact Sue Marone, who will add it to next week's collection. The SRI is a validated SLE disease activity instrument used to detect clinically meaningful improvement of disease in SLE clinical trials. , Landis RC , Kiani AN The 4-point PGA (0, no flare; 1, mild; 2, moderate; 3, severe) showed the lowest IRR in assessing flare (ICC=0.18) compared with the BILAG-2004 (ICC=0.54) and SFI (ICC=0.21) [65]. , Alarcn GS In our centre, new tools for the assessment of SLE activity: the Lupus Activity Scoring Tool (LAST) and Clinical Lupus Activity Scoring Tool (C-LAST) were developed and validated. , Rairie JE et al. inflammation (duration and severity of morning stiffness as measured by BASDAI). X 20 sentence examples within Physician Global Assessment. , Urowitz MB. Objective Existing methods for grading lupus flares or improvement require definition-based thresholds as increments of change. , Socher SA Arthritis Res Ther. , Navarra SV 2. , Engle E Introduction Physician global assessments of disease activity (medical doctor (MD) globals) are important outcomes. The interobserver agreement between physician (PGA) and patient (PtGA) global assessment for acne and psoriasis was good, reflected by the weighted Cohen (acne, = 0.68; psoriasis, = 0.70) (eTable in the Supplement). Mok CC , Urowitz MB , Kharboutli M FOIA Methods: This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items . To increase its reliability, the PGA should be scored by a physician with significant expertise in SLE, with prior knowledge of laboratory results [112], considering the overall disease activity at the time of the visit and comparing it to the last visit in order to assess flares [9]. , Pego-Reigosa J-M Mina R The literature search identified 93 articles, and 12 additional articles were retrieved from the reference list of those publications. Schlencker A, Messer L, Ardizzone M, Blaison G, Hinschberger O, Dahan E, Sordet C, Walther J, Dory A, Gonzalez M, Kleinlogel S, Bramont-Nachman A, Barrand L, Payen-Revol I, Sibilia J, Martin T, Arnaud L. Lupus Sci Med. Navarra SV , Kalunian K Currently the lack of standardized scoring, as well as the subjectivity of the physician judgements, can be an important source of heterogeneity, especially in trials. Deconstruction of the safety of estrogen in lupus erythematosus national assessment-systemic lupus erythematosus disease activity index flare index, Effect of raloxifene on disease activity and vascular biomarkers in patients with systemic lupus erythematosus: subgroup analysis of a double-blind randomized controlled trial, Omega-3 in SLE: a double-blind, placebo-controlled randomized clinical trial of endothelial dysfunction and disease activity in systemic lupus erythematosus, Erythrocyte sedimentation rate is a predictor of renal and overall SLE disease activity, Characterization of clinical photosensitivity in cutaneous lupus erythematosus, Validation of the systemic lupus erythematosus responder index for use in juvenile-onset systemic lupus erythematosus, Depressive symptoms and associated factors in systemic lupus erythematosus, Validation of the Portuguese simple measure of impact of lupus erythematosus in youngsters (SMILEY) in Brazil, Anti-C1q antibodies have higher correlation with flares of lupus nephritis than other serum markers, Performance of anti-C1q, antinucleosome, and anti-dsDNA antibodies for detecting concurrent disease activity of systemic lupus erythematosus, An assessment of disease flare in patients with systemic lupus erythematosus: a comparison of BILAG 2004 and the flare version of SELENA, Noncalcified coronary plaque in systemic lupus erythematosus, Decreases in anti-double-stranded DNA levels are associated with concurrent flares in patients with systemic lupus erythematosus, Validity and reliability of lupus activity measures in the routine clinic setting, Clinical predictors of response and discontinuation of belimumab in patients with systemic lupus erythematosus in real life setting. This suggests that the role of the PGA is limited for disease activity assessment when used as a single instrument. Observed and articulated management issues and responses. , Garabajiu M Construct validity. , Gladman DD BILAGAB . , Bocci EB The Physician's Global Assessment (PhGA) is a number without unit. , Petri M. Thanou A Methods: , Petri M The SRI is a composite instrument comprised of the SELENA-SLE Disease Activity Index [SELENA-SLEDAI], Physician Global Assessment (PGA) and British Isles Lupus Assessment Group (BILAG) 2004. The official NJDOE Incident Reporting Form, as well as a guide to completing Epub 2014 Apr 11. Methods The site is secure. Help us improve CareerBuilder by providing feedback about this job: Report this job Job ID: 2281236908. Piga M This important heterogeneity in the anchoring of the PGA prevented us from performing a meta-analysis of reliability data. This potentially disfiguring disease can have significant impact on patient's quality of life (QoL) and is often refractory to many first- and second-line therapies. Methods This SLR was conducted by two independent reviewers in accordance with the PRISMA statement. In this sense, criterion validity of PGA is satisfied when scores correlate with phenomena subsequently influenced by disease activity, such as quality of life measurements (Health-related Quality of Life, 36-item Short Form Health Survey, Functional Assessment of Chronic Illness TherapyFatigue score, Lupus Impact Tracker and LupusPRO), biomarker levels (complement fractions, ESR, autoantibodies), treatment variations and damage assessments (SDI). In 16 studies the PGA was used as a mean to assess changes in disease activity after treatment [3, 12, 22, 29, 40, 42, 43, 52, 54, 56, 57, 80, 85, 87, 95, 98, 101]. , Lin M In the absence of a consensus, Aranow [26] found a better correlation between the SLEDAI and the PGA when the latter was assessed taking into account laboratory test results. Construct validity was demonstrated by a good correlation (r 0.50) between the PGA with the SLEDAI (12 studies), SLAM (4 studies), LAI, BILAG and ECLAM (2 studies each). Your comment will be reviewed and published at the journal's discretion. Chaigne B The interRR was assessed in seven studies [4, 10, 11, 36, 65, 68, 94], showing values ranging from 0.67 [68] to 0.96 [94]. Mokkink LB T2 - A longitudinal study. , Clowse M. Moorthy LN Truth refers to whether the measure provided by the scores is able to measure what was intended [18]. Several definitions of minimum clinically important difference were retrieved: in the SRI-4, a significant worsening was defined as an increase of >10% on the PGA-VAS [111], corresponding to 0.3 points from baseline; Touma et al. How should lupus flares be measured? Lead Medical Director heading up the global collaboration with Pfizer for Enbrel trials. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. government site. , Kosinski M IgM) on attainment PhGA. The correlation with the SLEDAI was determined in 12 studies (Fig. MeSH All rights reserved. Liang MH The Janus kinase (Jak)/signal transducer and activating protein (STAT) pathways mediate the intracellular signaling of cytokines in a wide spectrum of cellular processes. , Urowitz MB. , Jolly M. Mok CC , Mohan C. Jolly M The PGA intraRR was assessed in three studies [10, 68, 94] and ranged from 0.55 [68] to 0.88 [10]. , Fortin PR , Dyer JW , Petri M. Foering K The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. In one study [25], the PGA of disease activity resulted from the combination of the clinical visit, laboratory markers evaluation and the physicians knowledge of the patient disease history. disease activity in SLE, with the Physician Global Assessment (PGA) being the only one included in the updated EULAR recommendations for the management of SLE.11. , Longenecker JC In Fatemi et al. The Systemic Lupus Activity Measure-revised, the Mexican Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and a modified SLEDAI-2K are adequate instruments to measure disease activity in systemic lupus erythematosus. Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. A new tool -- the Lupus Activity Scoring Tool (LAST) - has been proposed to join the ranks of current disease activity indices. Cloud, mobility, security, and more. Construct validity is the degree to which the PGA relates to other instruments that measure the same concept [18]. Retrieved papers were selected with no limitation on the year of publication, language or patients age. This scoring modality was used for the SRI [3]. Diet and Systemic Lupus Erythematosus (SLE): From Supplementation to Intervention. , Tanangunan R , Bentow C The Physician Global Assessment International Standardisation COnsensus in Systemic Lupus Erythematosus (PISCOS) study aimed to obtain an evidence-based and expert-based consensus standardisation of the Physician Global Assessment (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). Barr SG 2014 Sep-Oct;10(5):309-20. doi: 10.1016/j.reuma.2014.01.012. et al. disease activity). The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. LECTURE 10: MEDICAL SURGICAL NURSING. Supervise the development of junior medical affairs staff . Clinical composite measures of disease activity and damage used to evaluate patients with systemic lupus erythematosus: A systematic literature review. Oxford Textbook of. ECG - correct answer no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. Conclusion: [2, 21, 24] recommended PGA assessment prior to reviewing serological data, based only on the clinical visit. Face validity was reported in all the articles retrieved in which the PGA was used alone or as part of composite indices (Systemic Responder Index, Safety of Estrogen in Lupus Erythematosus National Assessment Flare Index, Lupus Low Disease Activity State, Definitions of Remission in Systemic Lupus Erythematosus criteria). , McGuire JL. Discrimination refers to whether the score (PGA-VAS) differentiates between situations of interest [18]: discrimination of the PGA measures the ability of the PGA-VAS to report a consistent score where no change in disease activity has occurred (reliability) and to detect a change when a change in disease activity has occurred (sensitivity to change or responsiveness). Fanouriakis A A difference between the interRR of the PGA assessed by an untrained physician (ICC=0.50.63) or a trained investigator (ICC=0.790.81) was found [36]. The PGA was integrated in composite indices, including the definition of the LLDAS [12, 13, 29, 34, 37, 39, 40] and remission [29, 37] (Table1). Systemic lupus erythematosus (SLE) is a chronic autoimmune disease of multifactorial origin that can affect any organ or organ system, resulting in a broad spectrum of clinical manifestations ranging from dermatological involvement to multi-organ failure with episodes of relapses and remissions. A good responsiveness for PGA was shown in eight studies. , Shea BJ Improving patient pathways for systemic lupus erythematosus: a multistakeholder pathway optimisation study. , Gomez A 2014 Dec;53(12):2175-81. doi: 10.1093/rheumatology/keu153. Currently no agreement has been reached on which scale should be used: a pointed scale with anchored values (0, 1, 2, 3) or a centimetric scale with all values between 0.0 and 3.0. Of note, the literature search revealed heterogeneous definitions of physician assessment of disease activity other than the PGA (physician global assessment [4, 70, 73], physician overall assessment [85]). In conclusion, the PGA was demonstrated to be a valid, responsive and feasible instrument, but its reliability was strongly impacted by the scale adopted, suggesting the need for standardization in its scoring. SLE has protean and often complex manifestations, necessitating careful clinical assessment. Twenty-nine studies [25, 31, 3439, 41, 43, 48, 49, 5355, 59, 6164, 74, 75, 81, 82, 86, 92, 93, 96, 97] have assessed criterion validity of the PGA (Table2). , Giangreco D

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