Search Items Research Articles

Visual search for hazardous items: using virtual reality (VR) in laypersons to test wearable displays for firefighters

In virtual reality (VR), we assessed how untrained participants searched for fire sources with the digital twin of a novel augmented reality (AR) device: a firefighter’s helmet equipped with a heat sensor and an integrated display indicating the heat distribution in its field of view. This was compared to the digital twin of a current state-of-the-art device, a handheld thermal imaging camera. The study had three aims: (i) compare the novel device to the current standard, (ii) demonstrate the usefulness of VR for developing AR devices, (iii) investigate visual search in a complex, realistic task free of visual context. Users detected fire sources faster with the thermal camera than with the helmet display. Responses in target-present trials were faster than in target-absent trials for both devices. Fire localization after detection was numerically faster and more accurate, in particular in the horizontal plane, for the helmet display than for the thermal camera. Search was strongly biased to start on the left-hand side of each room, reminiscent of pseudoneglect in scene viewing. Our study exemplifies how VR can be used to study vision in realistic settings, to foster the development of AR devices, and to obtain results relevant to basic science and applications alike.

Concomitant Arthroscopic Superior Labral and Rotator Cuff Repair: A Systematic Review.

The aim of this study was to systematically review the literature on concomitant repair of superior labral and rotator cuff tears, in light of the paucity of published clinical evidence. A Preferred Reporting Items for Systematic Reviews and Meta-Analyses compliant search of PubMed, Embase, and Cochrane Library databases was performed for clinical studies of patients undergoing combined repairs of the rotator cuff and superior labrum. Ten studies comprising 241 shoulders were included, with a mean age of 52.6 years and mean follow-up of 29.0 months; 67.9% were male patients. Functional outcomes included the mean postoperative American Shoulder and Elbow Surgeons Standardized Shoulder Score of 88.6, University of California at Los Angeles Shoulder Score of 30.6, constant score of 90.4, Simple Shoulder Test score of 8.6, and visual analog scale score of 1.1. Range of motion outcomes demonstrated mean postoperative forward flexion of 159°, external rotation of 68°, and internal rotation of 17°. The overall return-to-play rate was 76.8%, with 67.9% returning to preinjury level. The overall complication rate was 4.1% with an 18.9% rate of rotator cuff retear and 2.4% reoperation rate. Arthroscopic concomitant repair of superior labral and rotator cuff tears results in good functional outcomes and range of motion, along with a low reoperation rate. Among athletes, there are moderate rates of return but lower rates of return to the same level of play. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Combination Immunotherapy With Radiotherapy in Non-Small Cell Lung Cancer: A Review of Evidence.

Radiotherapy plays a fundamental role in the treatment of patients with all stages of non-small-cell lung cancer (NSCLC). The emergence of immune checkpoint inhibitors (ICIs) has transformed the standard of care in these patients. The use of ICIs is increasingly utilized in the definitive setting as an adjunct to chemoradiotherapy or surgery and remains a vital component in the treatment of metastatic disease. Despite improvements in patient survival, the use of immunotherapy as monotherapy has shown limited overall response rates with susceptibility to resistance. Radiotherapy has been identified as a viable option to enhance the response rate to ICI and improve outcomes in NSCLC. We queried the English PubMed database utilizing variably combined search items including "radiation," "chemoradiation," "immune checkpoint," "immunotherapy," "stereotactic body radiotherapy," and "non-small-cell lung". We additionally searched various acceptable alternative terms for similar keywords such as "radiotherapy" in place of "radiation." These results were subsequently curated for relevance and impact on current treatment paradigms. In this review, we discuss preclinical and clinical studies relating to combinatorial use of immunotherapy and radiation in NSCLC. These studies are presented in the context of early-stage, operable stage III, unresectable stage III, and metastatic disease. The majority of the data illustrate promising results regarding the additive or synergistic effects of radiation and immunotherapy with a suggestion that the timing of these treatment modalities is crucial to optimizing outcomes. While there is now evidence regarding the favorable interplay between radiation and immunotherapy in NSCLC, there remain multiple unanswered questions which are expected to be addressed in ongoing clinical trials.

Negative Impact of Digital Technology on Children's Health

Digital technologies are being used widely by children and increased rapidly over the past decade. Digital Technology in all its forms (such as computers, smartphone, video games, and the interne) can hold a person’s attention for long periods. It seems that can negatively affect on eye, sleep, critical thinking, physical activity, musculoskeletal impacts for people of any age, children and adolescents is especially vulnerable. Children's incorrect use of technology in terms of content, duration, frequency, and posture when using it can lead to a number of health risks. The objective of this paper is an overview of negative effect of digital technology on children's health. And in order to achieve our goal, we addressed the following questions: Does overuse of digital technology have a negative effect on children health? Does using digital technology can make children’s developmental problems, musculoskeletal problems, physical inactivity, obesity, and inadequate sleep quality? It is great to monitor the time, frequency, and content viewed while using technological devices and to certify that children have or develop adequate physical activity opportunities, healthy eating habits, proper sleep cycles, and a nurturing social environment. This study is based on qualitative research methods, using literature review by a specific keywords and search items, in order to obtain as many relevant papers as possible. All collected papers are used to recognize and develop a paper based on the research questions. This research includes articles published between 2015 and 2023, articles published prior to 2015 are not included.

Health impact of urban green spaces: a systematic review of heat-related morbidity and mortality

ObjectivesThe objective of this review was to scrutinise the impact of urban green spaces on heat-related morbidity and mortality.DesignThis systematic review was meticulously carried out following the Preferred Reporting Items...

Comprehensive review of the heart failure management guidelines presented by the American College of Cardiology and the current supporting evidence.

Heart failure (HF) is a chronic condition that affects the heart's functional capacity, resulting in symptoms such as fatigue, edema, and dyspnea. It affects millions of adults in the United States and presents challenges in optimizing treatment and coordinating care among clinicians. Additionally, the various classifications for HF and limited research on treatment outcomes in heart failure with midrange ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF) further complicate the pharmacological management of patients with this disease. The objectives of this article are to review the pharmacotherapy guidelines for HF provided by the American College of Cardiology (ACC) and offer an update on the current trials conducted on these agents. The paper includes a post hoc analysis of established randomized controlled trials (RCTs), current RCTs, analysis of HF registries, and the guidelines published by the ACC. The gathering of research began in June 2023 and completed in August 2023. PubMed was utilized with the following search items: "treatment for HFrEF" (heart failure with reduced ejection fraction), "treatment for HFmrEF," and "treatment for HFpEF." The screening process was completed by one author. The automation tools utilized were "clinical trials," "randomized control trials," and "five years". Meta-analyses, systematic reviews, and case reports were excluded from the screening process. This review does not include research regarding medical devices, interventional therapies, and lifestyle modifications. Finally, research regarding additional comorbidities, nonpharmacological focused research, and agents not recommended by the ACC are not included in this paper. The search began with 6,561 records identified from PubMed, with 407 records screened after automation tools were utilized to filter for "clinical trials," "randomized control trials," "one year," and "five years". A total of 22 duplicates were reviewed, 318 were sought for screening after trials from 2019 were removed, and 31 studies were ultimately included in the review. A detailed summary of the most recent recommendations by the ACC are provided. The discussion includes indications, mechanisms of action, side effects, and contraindications for the selected agents. Additionally, recent clinical trials are included to provide evidence on the efficacy of the recommended classes of drugs. The current guidelines for managing HFrEF have been consistent, but there is limited consensus on treating HFmrEF and HFpEF. Large RCTs have provided compelling evidence supporting the use of the recommended pharmacological agents. However, despite the new effective treatment protocols, slow clinical inertia and underoptimization of HF management persist. Thus, it is crucial to synchronize care among clinicians involved in managing patients with this disease.

Unraveling the role of digital leadership in developing digital dynamic capabilities for the digital transformation of firms

PurposeWith the emergence of the digital era, the role of digital leaders in developing digital capabilities and driving their firms towards digital transformation has gained significant attention. Digital dynamic capabilities involve continuous engagement of leaders in sensing, seizing, and transforming activities needed to digitally transform their firms. However, little attention is given toward the role of digital leadership in developing digital dynamic capabilities. We seek to develop an understanding of the role of digital leadership in building digital dynamic capabilities for successful digital transformation.Design/methodology/approachWe conducted a systematic literature review and looked at relevant articles using Google Scholar, ScienceDirect, and Scopus databases with key search items being “digital leadership”, “dynamic capabilities”, “digital dynamic capabilities,”. We used AND, OR operators in between the key terms to search for the relevant articles.FindingsOur conceptual framework and propositions demonstrate the digital leader's role in building three core dynamic capabilities: digital sensing (technological trends, digital scouting, digital vision, future interpretation, and digital strategies), digital seizing (organizational agility and digital portfolio), and transforming (redesigning internal structures and ecosystem partnerships) for successful digital transformation.Originality/valueThis study pioneers an integrated framework that elucidates the role of digital leadership in fostering digital dynamic capabilities essential for successful digital transformation. While previous research has examined digital leadership and transformation in separate silos, our work bridges this gap by defining and dissecting three core capabilities—digital sensing, digital seizing, and transforming. By doing so, we offer both academic and practical communities a nuanced understanding of how digital leadership shapes dynamic capabilities. The study serves as a foundational roadmap for future research and offers actionable insights for organizations striving to navigate the complex landscape of digital transformation.

Invariant contexts reduce response time variability in visual search in an age-specific way: A comparison of children, teenagers, and adults.

Contextual cueing is a phenomenon in which repeatedly encountered arrays of items can enhance the visual search for a target item. This is widely attributed to attentional guidance driven by contextual memory acquired during visual search. Some studies suggest that children may have an immature ability to use contextual cues compared to adults, while others argue that contextual learning capacity is similar across ages. To test the development of context-guided attention, this study compared contextual cueing effects among three age groups: adults (aged 18-33 years, N = 32), teenagers (aged 15-17 years, N = 41), and younger children (aged 8-9 years, N = 43). Moreover, this study introduced a measure of response time variability that tracks fluctuations in response time throughout the experiment, in addition to the conventional analysis of response times. The results showed that all age groups demonstrated significantly faster responses in repeated than non-repeated search contexts. Notably, adults and teenagers exhibited smaller response time variability in repeated contexts than in non-repeated ones, while younger children did not. This implies that children are less efficient at consolidating contextual information into a stable memory representation, which may lead to less stable attentional guidance during visual search.

Migrating Mobile Applications to the Web: Adult Crash Cart Training.

Nurses and clinicians require knowledge and training of their facilities' code blue response cart to manage emergency scenarios. However, the nurses who access the carts change frequently through turnover and role changes. An augmented reality training solution was built for mobile devices, but encountered distribution and access challenges. This study evaluated the conversion of the mobile application to a desktop-based version deployed via a learning management system. Eight hundred fifty clinicians were assigned the interactive learning product, which collected anonymous usage data and an optional feedback survey within the module. Of 850 assigned users, 468 completed the module, and 338 completed the feedback survey. Respondents indicated a positive difference of 25.3% in retrospective pre/post confidence and an appreciation for the features of the product. Performance measured by decreasing total item search time appeared to level off after three plays. The format transition was successful, allowing the same widespread distribution as the mobile versions of [X]. Feedback gathered will drive improvements in the module.

Development and Validation of Performance-Based Assessment of Daily Living Tasks in Age-Related Macular Degeneration.

To establish the reliability and validity of five performance-based activities of daily living task tests (ADLTT), to correlate structure to function, to evaluate the impact of visual impairment (VI) on age-related macular degeneration (AMD), and to develop new outcome measures. A multidisciplinary team developed five ADLTTs: (1) reading test (RT); (2) facial expression (FE) recognition; (3) item search (IS) task; (4) money counting (MC) task; and (5) making a drink (MD), tested with binocular and monocular vision. ADLTTs were tested for known-group (i.e., difference between AMD group and controls) and convergent (i.e., correlation to other measures of visual function), validity metrics, and test-retest reliability in 36 patients with VI (visual acuity (logMAR VA > 0.4) in at least one eye caused by AMD versus 36 healthy controls without VI. Compared to controls, AMD patients had a slower reading speed (-77.41 words/min; P < 0.001); took longer to complete MC using monocular worse eye and binocular vision (15.13 seconds and 4.06 seconds longer compared to controls, respectively; P < 0.001); and MD using monocular worse eye vision (9.37 sec; P = 0.033), demonstrating known-group validity. Only RT and MC demonstrated convergent validity, showing correlations with VA, contrast sensitivity, and microperimetry testing. Moderate to good test-retest reliability was observed for MC and MD (interclass correlation coefficient = 0.55 and 0.77; P < 0.001) using monocular worse eye vision. Real-world ADL functioning associated with VI-related AMD can be assessed with our validated ADLTTs, particularly MC and MD. This study validates visual function outcome measures that are developed for use in future clinical practice and clinical trials.

DEVELOPMENT OF A SOFTWARE SYSTEM FOR SEARCHING FOR LOST ITEMS

The article presents an approach to developing a software system to facilitate the efficient search for lost items. As part of the study, the authors designed an integrated system that includes server, web, and mobile versions, which provides broad opportunities for identifying and returning lost property. In large urban agglomerations, the loss of personal items becomes a common problem. Existing solutions are often limited to preventive measures and do not provide sufficient support after the item’s loss. The lack of an effective feedback and identification system complicates the lost property search process. The developed system uses modern technologies such as Django for the backend, JavaScript for the web interface, and Flutter for creating cross-platform mobile applications. This approach makes it possible to expand the list of system users to the maximum extent. Django, a capable web framework, facilitates reliable data management and integration with various interfaces. The study involved the development of a database to provide storage and processing of all the necessary information. Using REST API ensured efficient interaction between the system’s server, web, and mobile parts. This approach allows different system components to exchange data in a unified format. The system lets users register individuals and legal entities, which makes it possible to use it in a wide range of public spaces. It helps to effectively search for and return lost items on the street and in public places, including restaurants, theatres, and transport hubs where lost items often occur. The software system created in this study addresses the critical problem of losing personal items. Widespread use of this system across various sectors could dramatically improve managing lost and found operations, turning a typically disorganised and ineffective process into an efficient, technology-driven one. The system’s implementation has the potential to significantly reduce the time and resources spent on searching for lost property and increase the productivity of lost property offices. Keywords: software system, item search, location, lost property office.

The Impact of Peri-Implant Diseases on the General Status of Patients with Cardiovascular Diseases: A Literature Review.

The aim of this study is to connect peri-implantitis to cardiovascular diseases, following the association found between periodontitis and cardiovascular conditions in recent years. PubMed, Scopus, Web of Science online databases were searched up to June 2023, with the exclusion criteria being research written in a language other than English. The MeSH search items were as follows: ["peri-implant health OR peri-implantitis OR peri-implant mucositis OR peri-implant disease"] AND ["cardiovascular diseases"]. Patient/population (P), intervention (I), comparison (C), outcome (O) framework questions were followed to identify the clinical evidence for the systematic review. Only clinical studies that used a control group to compare the relationship between cardiovascular diseases and peri-implantitis were selected. A total of 118 studies were identified through electronic search of the keywords. After removing duplicates, there were 76 records to be screened. Upon exclusion of ineligible titles and abstracts, 27 studies remained for evaluation. Finally, 23 studies were excluded for not meeting the inclusion criteria, leaving 4 studies to be included in the qualitative analyses. This study found there is a linear association between mucosal/gingival inflammation and carotid intima-media thickness test (c-IMT) values. Peri-implant mucosal inflammation could be a contributor to the vascular disease burden of an individual; further specific clinical studies should be performed in order to demonstrate this connection.

Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies.

Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue. The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ' myocardial strain', 'left ventricular mechanics', 'longitudinal global strain', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular ejection fraction', and 'obesity'. Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): -0.86 ± 0.08; confidence interval (CI) -1.02 to -0.69, P < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD -0.27 ± 0.06; CI -0.40 to -0.15, P < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m 2 , data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD -1.24 ± 0.19, CI -1.61/-0.87, P < 0.0001) than by LVEF (SMD -0.54 ± 0.27, CI -1.07 to -0.01, P = 0.046). The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.

Testing the contributions of proactive target and distractor templates in visual search performance

ABSTRACT When searching for objects with particular visual features, performance is sometimes improved by the presence of a salient colour distractor, such as a red item among green objects. Attention to such distractors is thought to be suppressed when the visual system expects their specific features (e.g., redness), but a complication with this view is that distractor expectancies are generally accompanied by anticipated target features, with their own associated attentional facilitation. We tested the role of these mechanisms by separately manipulating the colour specificity of salient distractors and of targets, and thus the ability to build up feature-specific templates for each type of search item. Experiment 1 employed singleton distractors appearing in unpredictable colours, preventing the formation of a feature-specific suppression template. Nevertheless, evidence of suppression was unchanged, suggesting that it does not require a fixed, predictable distractor. In Experiment 2, the singleton colour remained fixed while the target colour varied. Without a constant target colour, markers of singleton suppression were effectively abolished. The pattern of results suggests that observed suppression effects are largely driven by global enhancement of the expected target colour, possibly in combination with a second-order suppression mechanism that is not dependent on specific distractor features.

Effects of Rinsing with Povidone-Iodine during Step II Periodontal Therapy: A Systematic Review and Meta-Analysis.

Background and Objectives: Antiseptics have been suggested to enhance the outcomes of non-surgical periodontal treatment (NSPT). Among these, povidone-iodine (PVP-iodine) was reported to significantly reduce periodontal pocket depths (PPDs). The aim of this study was to systematically re-assess the existing literature regarding the potential benefit of using PVP-iodine in step II periodontal therapy. Material and Methods: The scientific literature was systematically searched across electronic libraries for randomized controlled trials employing PVP-iodine during NSPT through to September 2023, using search items related to PVP-iodine and periodontitis. The selection process was performed by two independent reviewers. The primary outcomes were reductions in periodontal probing depth (PPD) and clinical attachment level (CAL). When reasonable, a meta-analysis of the included studies was performed. Results: Initially, 799 records were identified. After abstract and title screening and fulltext revision, 15 RCTs were included. The data from eight studies were merged in meta-analyses. The use of PVP-iodine had no significant effect on PPD reduction at 6 months (means [standard deviation]: -0.12 mm [-0.33; 0.09]) but it did at 12 months (-0.29 mm [-0.56; -0.02]). CAL was significantly better at 6 (-0.42 mm [-0.64; -0.20]) and 12 months (-0.39 mm [-0.66; -0.11]). Conclusions: PVP-iodine rinsing during NSPT may slightly improve patients' PPD and CAL.

Inter-trial priming is not sufficient for feature-based distractor suppression

ABSTRACT Previous research has shown that observers can learn to suppress a salient distractor (e.g., a unique red item among green ones) when its salient feature (red) remains constant. Several authors suggested that such suppression builds up through repetition of the distractor’s salient feature via intertrial priming. Support for this account primarily comes from the finding that interference from a salient distractor is weaker when this distractor’s salient colour repeats on successive trials than when the distractor takes on the previous target’s colour. Here, we tested an alternative account, unrelated to distractor suppression, according to which this priming effect reflects increased distraction when the salient distractor shares the previous target’s colour rather than a decreased distraction when this distractor’s colour repeats. To dissociate the two accounts, we randomly selected the distractor and the other search items’ colours from four possible colours. Thus, on successive trials, the distractor and target colours could repeat, be new or swap. We found that relative to the new-colour condition, distractor interference increased when the distractor took on the previous target colour, but was unaffected by whether the distractor’s colour repeated. Our findings challenge the claim that intertrial priming accounts for distractor suppression.

From database to practice: the MBSAQIP in the surgical literature

BackgroundThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) has been a game changer for metabolic and bariatric surgery (MBS), with continuous improvements in safety and outcomes throughout the years of its usage. It allows in-depth evaluations of MBS procedures, presenting practitioners and researchers with unparalleled opportunities for quality assessment, research and clinical advancement. ObjectivesTo offer an updated overview of MBSAQIP-related publications. SettingUnited States. MethodsPubMed was queried using keywords “MBSAQIP” and “Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.” Letters to editors, duplicates, commentaries, and retracted articles were excluded. Studies that mentioned MBSAQIP but did not use the data within were also excluded. ResultsA total of 400 search items were returned as of August 2023. After exclusions, 289 studies were reviewed. Articles were published in a total of 28 unique journals, the majority of which were featured in Surgery for Obesity and Related Diseases (SOARD), with 114 articles (39.4%). Sixty-one articles were focused on creating predictive models or risk calculators, 58 on investigating the safety of procedures, and 52 on exploring complications. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) were the 2 most commonly discussed procedures, at 80.3% and 80% respectively. Forty-three studies included patients who underwent robotic-assisted MBS. ConclusionsThe MBSAQIP is a valuable resource that has generated a wealth of studies in the literature. It has allowed for intense analysis of clinical issues and fostered a culture of safety and quality improvement. Participating surgeons must pledge commitment to extended follow-up periods to maximize its effectiveness.

Reading problems and their connection with visual search and attention.

Attention has been hypothesized to act as a sequential gating mechanism for the orderly processing of letters and words. These same visuoattentional processes are often assumed to partake in some but not all types of visual search. In the current study, 24 dyslexic and 36 typical readers completed an attentionally demanding visual conjunction search. Visual feature search served as an internal control. It has been suggested that reading problems should go hand in hand with specific problems in visual conjunction search-particularly elevated conjunction search slopes (time per search item)-often interpreted as a problem with visual attention. Results showed that reading problems were associated with slower visual search, especially conjunction search. However, reading deficits were not associated with increased conjunction search slopes but instead with increased search intercepts, traditionally not interpreted as reflecting attention. We discuss these results in the context of hypothesized visuoattentional problems in dyslexia. Remaining open to multiple interpretations of the data, the current study demonstrates that difficulties in visual search are associated with reading problems, in accordance with growing literature on visual cognition problems in developmental dyslexia.

Robotic Assistant for Object Recognition Using Convolutional Neural Network

Visually impaired persons encounter certain challenges, which include access to information, environmental navigation, and obstacle detection. Navigating daily life becomes a big task with challenges relating to the search for misplaced personal items and being aware of objects in their environment to avoid collision. This necessitates the need for automated solutions to facilitate object recognition. While traditional methods like guide dogs, white canes, and Braille have offered valuable solutions, recent technological solutions, including smartphone-based recognition systems and portable cameras, have encountered limitations such as constraints relating to cultural-specific, device-specific, and lack of system autonomy. This study addressed and provided solutions to the limitations offered by recent solutions by introducing a Convolutional Neural Network (CNN) object recognition system integrated into a mobile robot designed to function as a robotic assistant for visually impaired persons. The robotic assistant is capable of moving around in a confined environment. It incorporates a Raspberry Pi with a camera programmed to recognize three objects: mobile phones, mice, and chairs. A Convolutional Neural Network model was trained for object recognition, with 30% of the images used for testing. The training was conducted using the Yolov3 model in Google Colab. Qualitative evaluation of the recognition system yielded a precision of 79%, recall of 96%, and accuracy of 80% for the Robotic Assistant. It also includes a Graphical User Interface where users can easily control the movement and speed of the robotic assistant. The developed robotic assistant significantly enhances autonomy and object recognition, promising substantial benefits in the daily navigation of visually impaired individuals.

Twenty First Century Treatments for a Nineteenth Century Disease: Polymyalgia Rheumatica

Objective: Polymyalgia Rheumatica (PMR) was first described in the 19th century in five elderly men in the Scottish spa at Strathpeffer by Dr. William Bruce [1]. The treatment of this common, painful, disabling condition has been corticosteroids virtually since these were first introduced to clinical practice 70 years ago [2]. This condition is the commonest reason for long term use of corticosteroids in the elderly. The side-effects of these agents are severe, and this is especially true in older age groups. The recent introduction of biological Disease Modifying Antirheumatic Drugs (DMARDs) and newer synthetic DMARDs has raised hope that effective treatment of PMR can be offered, and the serious side-effects of traditional steroid treatment circumvented. This review offers a summary of recent attempts to use these new antirheumatic agents. Methods: The authors searched Medline and PubMed using the search items polymyalgia rheumatica, giant cell arteritis and temporal arteritis over the past fifteen years. As much as possible, this search focused on treatment of PMR and Giant Cell Arteritis (GCA) with corticosteroids and newer synthetic and biological DMARDs where outcomes including toxicity and side-effects could be assessed. Results: The reports in the literature of the exhibition in PMR of a wide range of treatments including the newer organic and biological DMARDs have been reviewed. To date no entirely satisfactory alternative to corticosteroids for the control of this disease has been reported. Conclusion: Some of the newer DMARDs have shown promise in the management of PMR but, to date, no agent has been found adequate to replace the use of corticosteroids in the treatment of this disease.