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, Jolly M. Ribi C Use of Physician Global Assessment in systemic lupus erythematosus: a MD globals may vary based on their age, gender, practice setting and experience (number of patients seen per year and years in practice). Different definitions of disease activity according to the PGA instrument. Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. , Schirmbeck LA Reviews and case series with fewer than five patients were excluded. , Tanangunan R Lai J-S et al. Jiao H, Acar G, Robinson GA, Ciurtin C, Jury EC, Kalea AZ. 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. 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. The PGA intraRR was assessed in three studies [10, 68, 94] and ranged from 0.55 [68] to 0.88 [10]. A good correlation was considered for a value >0.60. The aim of this systematic literature review is to describe and analyse the psychometric properties of the PGA. Touma Z 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. In 1988, Liang et al. Medizinische Universitt Graz Austria/sterreich - Forschungsportal T2 - A longitudinal study. Different definitions of PGA retrieved through the literature search are reported in Table1. 2014 Dec;53(12):2175-81. doi: 10.1093/rheumatology/keu153. Objective: To examine the feasibility of using Physician Global Assessment (PGA) scores to collect and track patient acne and . The literature search identified 93 articles, and 12 additional articles were retrieved from the reference list of those publications. 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). PDF Physician Global Assessment International Standardisation COnsensus in The anonymous patientcompleted questionnaire comprised the following: current pain in the past 7 days (10cm VAS [0 no pain; 10 most severe pain]), patient global assessment (PtGA) of health status (10 cm VAS [0 very well; 10 very poorly]), ever and current recreational cannabis use, ever and current medical cannabis use, and if cannabis . 8600 Rockville Pike 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. SLE is an autoimmune disease in which the immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs. The intrarater reliability (intraRR) is the ability to provide consistent scores in a stable population by the same assessor over time. Oxford Textbook of Neuropsychiatry - 2020 | PDF | Psychiatry Brunner HI 2. The results are similar, and less than half the time is required for scoring. Vil LM The aim of this systematic literature review (SLR) is to describe and analyse the psychometric properties of PGA. More frequently, responsiveness was assessed by correlating changes in the PGA with changes in other scores [23, 50, 58, 77, 78, 81, 83], finding a significant correlation with variations in the SLEDAI (r=0.390.66) [23, 77, 78], SLAM (0.61) [77], LAI (0.56) [77], patient global assessment (0.37) [77], SRI-50 (0.48) [78] and ESR (P<0.0001) [58], but not with C3, C4, circulating immunocomplexes and prednisone dose [77]. 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). Mina R Thus the development of a comprehensive index for assessing disease activity still represents one of the most important challenges in SLE [7]. LECTURE 10: MEDICAL SURGICAL NURSING. 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Correlations with other instruments measuring similar constructs should typically demonstrate a coefficient (r) 0.50 [106]. Higher disease activity is an important predictor of both organ damage and mortality [2] and the attainment of low disease activity is associated with a reduction in early damage [5, 6]. disease activity). 'Not at target': prevalence and consequences of inadequate disease control in systemic lupus erythematosus-a multinational observational cohort study. The .gov means its official. Once two investigators (E.C., M.P.) Barr SG Importance: In dermatology, the development of objective, standardized quality measures that can be used in a clinical setting is important to be able to respond to the needs of payers and credentialing and licensure bodies and to demonstrate dermatologic value. Thanou A, Chakravarty E, James JA, Merrill JT. PGA - Lupus Research J Clin Med. Navarra SV Five centres in Great Britain and the Republic of Ireland have collaborated to produce a computerized index of clinical disease activity in systemic lupus erythematosus, based on the principle of the physician's intention to treat. , Allen E 04 Measuring SLE disease activity in 2020: perspectives from clinical , Seaman AL In only one study [4], was PGA sensitivity assessed comparing the change with an anchor [109], represented by the treatment sensitive index: PGA sensitivity was found to be between that of the BILAG (highest sensitivity) and the SLEDAI (lowest sensitivity). 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. Content validity was reported in 89 studies. Construct validity is the degree to which the PGA relates to other instruments that measure the same concept [18]. , Jolly M. Mok CC They proposed a physician global score on a 10cm visual analogue scale (VAS) to be used as a gold standard to compare six disease activity instruments [4]. X 20 Physician Global Assessment 10.1136/lupus-2019-lsm.176 . Psychometric properties data were analysed according to the OMERACT Filter methodology version 2.1. 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). Funding: The study was funded through the training Bursary Programme 2019 of the SLEuro European Lupus Society. A prospective cohort study, Validity and reliability of retrospective assessment of disease activity and flare in observational cohorts of lupus patients, A novel lupus activity index accounting for glucocorticoids: SLEDAI-2K glucocorticoid index, Low disease activityirrespective of serologic status at baselineassociated with reduction of corticosteroid dose and number of flares in patients with systemic lupus erythematosus treated with belimumab: a real-life observational study, Definition and initial validation of a lupus low disease activity state (LLDAS), A framework for remission in SLE: consensus findings from a large international task force on definitions of remission in SLE (DORIS), Prolonged remission in Caucasian patients with SLE: prevalence and outcomes, 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus, PRISMA Group. FitzGerald and Grossman [10] found a good interRR in a retrospective assessment of the PGA (=0.79). 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. Face validity. [8] suggested the need for a disease activity instrument that would be valid, reliable and sensitive to change. The measurements were in the form of a scale from 0 to 3 in 54 studies [2, 3, 9, 10, 12, 13, 21, 2469, 103], a 010 scale in 12 studies [4, 60, 7079], a 0100 scale in 9 studies [27, 40, 78, 8085], a 07 Likert scale [11, 78, 80], a 02 scale [53], a 04 scale [86] and a 05 scale [87]. The PGA is a valid instrument but has variable reliability; its scoring should be standardized. 2022 Mar 14;24(1):70. doi: 10.1186/s13075-022-02756-3. 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]. Randomized MMF Withdrawal in Systemic Lupus Erythematosus (SLE) - Full Associations between physicians' global assessment of disease activity Touma Z The LUMINA (Lupus in Minorities: Nature versus Nurture) study and other trials have offered evidence of a decrease in flares and prolonged life in patients given hydroxychloroquine, making . Eudy AM , Sjwall C. Strand V All clinical diagnoses were verified by review of the patients' inpatient and outpatient files at the time of capillaroscopy. Physician global assessment in systemic lupus erythematosus: Can we SLE3. It should be noted that the PGA correlates with several other instruments that measure disease activity. et al. 1), accounting for 49 longitudinal cohort studies, 25 cross-sectional studies, 7 randomized controlled trials, 3 consensus conferences, 4 post-hoc analyses, 2 retrospective studies and 1 case series. In this systematic review we have analysed the measurement properties of the PGA, including the validity, reliability, responsiveness and feasibility. , Bertsias G , Chakravarty E 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. Patient-reported outcomes (PROs) reflect the patient's perspective and are used in rheumatoid arthritis (RA) routine clinical practice. et al. , Sjwall C This systematic literature review was conducted by two independent reviewers in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinicians judgement of overall SLE disease activity. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). , Chatzidionysiou K Newark, New Castle, USA, March 03, 2023 (GLOBE NEWSWIRE) -- The global complement-targeted therapeutics market is expected to grow at a CAGR of 8.9% from 2022 to 2030, owing to the rising . Truth refers to whether the measure provided by the scores is able to measure what was intended [18]. According to the authors, this difference was probably due to the greater familiarity of the physicians with the BILAG-2004 index. No data were found regarding the feasibility of the PGA. , Engle E Reliability measures the reproducibility of the instrument: it refers to the degree of agreement between different observers (interrater) and in the same observer over time (intrarater). , Koutsoviti S 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). Ragai Kiriakos, MD, MSc - Clinical Trials Physician - LinkedIn 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 . In one open-label study [43], the decrease in PGA score was considered the primary endpoint. Results: No study has evaluated the feasibility of the PGA in SLE to date. Bookshelf , Flower C A good responsiveness for PGA was shown in eight studies. inflammation (duration and severity of morning stiffness as measured by BASDAI). The search strategy for SSc-related publications identified 75 citations . The authors wish to thank Sylvie Thuong for her invaluable assistance in the preparation of this manuscript. Manzi S , Matos A Forbess LJ Castrejn I, Ra-Figueroa I, Rosario MP, Carmona L. Reumatol Clin. , Buyon J et al. Rendas-Baum R, Baranwal N, Joshi AV, Park J, Kosinski M. J Patient Rep Outcomes. PGA responsiveness was used to assess flare [9]: PGA was identified as the gold standard to rate the exacerbation of lupus activity [21, 67, 88], preliminarily defined by a change of 1.0 on a 03 VAS since the last visit. The sensitivity to change was estimated to be the smallest for the SLEDAI; the standardized response means were 0.48 when the physician global assessment was used as the standard and 0.01 when the patient global assessment was used . , Suriano A et al. , Pego-Reigosa J-M The Physician's Global Assessment (PhGA) is a number without unit. Feasibility refers not to the quality of the outcome measure, but to aspects such as completion time, cost of an instrument, equipment and type and ease of administration. physician global assessment (pga) - Assesschild Kiani AN , Alunno A Objective: , Gallacher AE We have systematically reviewed all studies about validation of the PGA in SLE. The site is secure. CareerBuilder TIP. Systemic Lupus Erythematosus and Lupus Nephritis - Epidemiology Because of its dynamic nature, this disease has an unpredictable natural course leading to high . [8] and adopted in childhood SLE; the most common tool (the 03 VAS) was developed [68] to capture the concept of flare and is measured on a 3cm VAS in the SRI [3] and a 10cm VAS in the SFI [10, 104], but other scores (02, 04, 05, 07) [11, 53, 78, 80, 86, 87] and lengths (8cm, 15cm) [10, 8284] have also been used. Moher D Using the Physician Global Assessment in a clinical setting to - PubMed The PGA was introduced in 1998 by a US Food and Drug Administration panel as the preferred tool to assess and record the severity of disease in clinical studies, and typically rates a patient's disease from 'clear' to 'severe' or 'very severe' [1, 2]. , Block JA PDF Use of Physician Global Assessment (PGA) in Systemic lupus - medRxiv , Kiani AN 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). 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]. Few studies reported on whether serological activity should be incorporated in the PGA. ATI Comprehensive Predictor Exam 2019 (180 Q & A, Verified and 100 It operates in Albuquerque, and New Mexico. 2021 Apr 8;5(1):33. doi: 10.1186/s41687-021-00298-x. , Friebus-Kardash J Before et al. , Gladman DD , Adamichou C , Gladman DD , Patrick DL Use of Physician Global Assessment in systemic lupus - PubMed Medical Cannabis Use by Rheumatology Patients Following Recreational Lead Medical Director heading up the global collaboration with Pfizer for Enbrel trials. et al. government site. Laboratory Investigation Results Influence Physician's Global , Longenecker JC The SELENA-SLEDAI assesses systemic lupus erythematosus (SLE) disease activity and categorizes mild/moderate or severe flares based on changes in the SLEDAI score, the Physician's Global Assessment (PGA), medication use (prednisone, Nonsteroidal anti-inflammatory drugs, Plaquenil, major immunosuppressives), other disease activity criteria, and . Face validity is satisfied when the instrument is considered able to capture what it should capture (i.e. Bethesda, MD 20894, Web Policies 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]. Quimby KR T1 - Associations between physicians' global assessment of disease activity and patient-reported outcomes in patients with systemic lupus erythematosus. . Criterion validity data reporting correlation coefficients between PGA and quality of life measures, laboratory markers and miscellaneous. TOTAL DOCUMENTS. A 21-numbered circle visual analog scale (VAS) may be a desirable alternative to the traditional 10-cm horizontal line for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ). Physician Global Assessment International - ScienceDirect , Petri MA , Socher SA , Vogel-Claussen J On stratifying the results by individual clinician, values ranged from 0.61 to 0.90, except for those reported by . Moreover, a difference between the interRR of the PGA assessed by an untrained physician (0.50.63) and a trained investigator (0.790.81) was found, suggesting the need for PGA scoring training or standardization [36]. , Giannakou I Navarra SV , Petri M Finally, the PGA enables the measurement of disease activity globally compared with a glossary-based index. et al. , Askanase A Patient global assessment in measuring disease activity in rheumatoid , Lau CS This suggests that the role of the PGA is limited for disease activity assessment when used as a single instrument. For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Kandane-Rathnayake R, Louthrenoo W, Hoi A, Luo SF, Wu YJ, Chen YH, Cho J, Lateef A, Hamijoyo L, Navarra SV, Zamora L, Sockalingam S, An Y, Li Z, Katsumata Y, Harigai M, Hao Y, Zhang Z, Kikuchi J, Takeuchi T, Basnayake BMDB, Chan M, Ng KPL, Tugnet N, Kumar S, Oon S, Goldblatt F, O'Neill S, Gibson KA, Ohkubo N, Tanaka Y, Bae SC, Lau CS, Nikpour M, Golder V, Morand EF; Asia-Pacific Lupus Collaboration. Merrill JT Ensure second line of defense Derivatives RWA reviews are performed consistently and . , Fang H Assessing disease activity in rheumatic diseases such as systemic lupus erythematosus (SLE) is vital for effective treatment. , Brunetta P Aranow C 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]. antineutrophil cytoplasmic antibody-associated vasculitis (AAV), and systemic lupus erythematosus (SLE). When expanded it provides a list of search options that will switch the search inputs to match the current selection. , Sengupta M , Mazur M. Fatemi A Unauthorized use of these marks is strictly prohibited. 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]. Physician training is very important. A high variability in scales was found, causing a wide range of reliability (intraclass correlation coefficient 0.67-0.98). (PGA) scoring of disease activity in systemic lupus erythematosus (SLE). The Physician Global Assessment (PGA) is a visual analogue score that reflects the clinician's judgement of overall SLE disease activity. Despite the need for new treatments in CLE . Background: Physician Global Assessment (PGA) is a visual analogue score (VAS) that reflects the clinician's judgment of overall Systemic Lupus Erythematosus (SLE) disease activity. , Lerman RH The correlation with the SLEDAI was determined in 12 studies (Fig. A multi-item Physician Global Assessment scale to assess psoriasis Uribe AG, Vil LM, McGwin G Jr, Sanchez ML, Reveille JD, Alarcn GS. et al. [35], the PGA correlated, although moderately, with the need for treatment change (r=0.46, P<0.01). PDF Getting To Know Dr. Derek Shendell, New Safe Schools Project Director 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. The Author(s) 2020. Psychometric properties of FACIT-Fatigue in systemic lupus erythematosus: a pooled analysis of three phase 3 randomised, double-blind, parallel-group controlled studies (BLISS-SC, BLISS-52, BLISS-76). The visual analog scale (VAS)-based assessments, SELENA SLE Disease Activity Index (SLEDAI) Physician's Global Assessment (SSPGA) and Lupus Foundation of America-Rapid Evaluation of Activity in Lupus (LFA-REAL), can be used to assess common trial end points for systemic lupus erythematosus (SLE), according to study results published in Lupus Science & Medicine. , Altman DG Comparison of the validity and sensitivity to change of 5 activity indices in systemic lupus erythematosus. Criterion validity is defined as the degree to which the scores of an instrument adequately reflect the truth in the form of a gold standard [107]. There is no cure for lupus, but medical . , Burlingame RW Epub 2014 Jul 10. , Petri M. Iaccarino L In an epratuzumab trial, the absence of deterioration of the PGA (not >10% worsening) was one of the items to achieve a BILAG-based Composite Lupus Assessment (BICLA) response [105]. Barr et al. et al. Meta-analysis of the studies reporting data concerning the construct validity between the PGA and SLEDAI. Because of the complexity of SLE, the assessment of disease activity is particularly challenging [3]. , Jolly M. Antony A , Karp DR The pooled correlation coefficient (95% CI) is given both for the fixed effects model and the random effects model. 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