Comparative study of self-rating pain scales in osteoarthritis patients.

Although progress has been made in the clinical metrology of pain in osteoarthritis, much further work remains. The preferred methods of measurement remain debatable. In this longitudinal, open study, a comparison of eight self-rating pain scales has been conducted. A total of 333 patients entered the four-week study after completing a 3-7 day NSAID-free washout period. Patients were assigned to treatment with oxaprozin 1200 mg p.o. once daily with titration permitted between 600 mg and 1800 mg. Rescue analgesia with acetaminophen (paracetamol) 325 mg (maximum 2600 mg) was allowed. At the end of the washout and the treatment period, patients completed eight self-administered pain scales. All pain measures detected clinically important and statistically significant improvements in pain. The pain scales differed in their degree of responsiveness. The Likert and visual analogue scales and their primary variations (continuous chromatic analogue and numerical scales) were more responsive than more complex measures. A positive correlation between initial pain rating and subsequent pain relief was confirmed in this study. We conclude that, while pain is a subjective sensory phenomenon, its perceived severity can be evaluated using a variety of self-administered pain scales, all of which are capable of detecting improvements in health status following effective pharmacological intervention.     

An evaluation of the effectiveness of a videotape programme on interobserver reliability in outcome assessment for ankylosing spondylitis

Aims. A study was designed to assess the effects of a standardized instructional videotape on training senior medical students to acceptable levels of reliability in performing several commonly used obsever dependent outcome measures in patients with ankylosing spondylilis (AS). Methods. During a single day, six third-year medical students independently examined five patients with AvS in predetermined order using a Latin Square design, before and after viewing a standardized videotape demonstrating 14 examination techniques. Reliability coefficients were calculated based on the variance components of the analysis of variance (ANOVA) table. Results. Prestandardization reliability coefficients were < 0.80 for three measures. Following standardization 12 reliability coefficients exceeded 0.80. For the majority of measures prestandardization reliability coefficients were high and no further improvement in reliability could be demonstrated. Conclusions. High levels of interobserver agreement were noted prior to viewing the instructional videotape. This may represent the success of undergraduate clinical skills training programmes, or it may be the result of having reviewed an illustrated instructional text just prior to the initial patient examinations. With the exception of chest excursion, high levels of prestandardization reliability, by necessity, precluded the demonstration of significant effects from viewing the videotape. Nevertheless, the data indicate that senior medical students arc capable of reliably performing quantitative measurement in AS. Recent surveys in Canada and Australia, showing a general lack of quantitative clinical measurement in the longitudinal follow up of AS outpatients by rheumatologists, suggest that the lack of quantitation is not due to inability to reliably perform the measurements.     

Perceptual variation in categorizing individual peripheral joints for the presence or absence of osteoarthritis using a standard homunculus: observations based on an australian twin registry study of osteoarthritis

The clinical diagnosis of osteoarthritis in the peripheral skeleton is dependent on the skilled examination of several features characteristic of the condition. However, we have previously observed that even highly experienced rheumatologists in Australia and Canada may not completely agree on the clinical examination in individuals with osteoarthritis (OA), rheumatoid arthritis, ankylosing spondylitis, fibromyalgia, scleroderma and painful shoulder.     

口服Carvedilol治疗心力衰竭多中心研究(MOCHA)

标题　Ｃａｒｖｅｄｉｌｏｌ对慢性心力衰竭患者左心室功能的改善和存活的提高呈剂量相关性作者　ＢｒｉｓｔｏｗＭＲ，ＧｉｌｂｅｒｔＥＭ，ＡｂｒａｈａｍＷＴ，等　　Ｃｉｒｃｕｌａｔｉｏｎ１９９６，９４：２８０７～２８１６　　研究疾病：充血性心力衰竭。目的：对Ｃａｒｖｅｄｉｌｏｌ治疗慢性心力衰竭患者剂量－疗效特征进行评价。　　设计：随机、双盲、安慰剂对照的多中心研究，剂量效应关系研究。病人资料：共３４５名心力衰竭患者，年龄１８～８５岁，左室射血分数≤０－３５，心力衰竭症状时间≥３月，研究前所有患者必须用利…     

Comparison of computed tomography and conventional radiology in the assessment of treatment response of lytic bony metastases in patients with carcinoma of the breast

Full skeletal survey, localised radiographs and computed tomography (CT) examinations were compared with clinical assessment in the evaluation of treatment response of bony metastases in 20 patients with carcinoma of the breast. Conventional radiology, skeletal survey and localised views compared poorly with clinical assessment agreeing in only 35% and 50% respectively. CT concurred with the clinical assessment in 65% of patients, particularly with respect to healing (86%). CT predicted the effect of treatment in six additional patients and this was confirmed on follow-up assessment. It is suggested that the use of skeletal surveys in monitoring treatment response is limited and that for critical evaluation of treatment CT should be the method of choice.     

Association of achalasia and pulmonary Mycobacterium fortuitum infection

A case of achalasia complicated by Mycobacterium fortuitum pulmonary infection and empyema is reported. This association has been documented in the medical literature. Possible mechanisms explaining this association are discussed.     

Congestive cardiomyopathy in association with AIDS

During a 10-month period in 1985 and 1986, three cases of acquired immunodeficiency syndrome (AIDS) and a rapidly progressive fatal cardiomyopathy were encountered. All three patients originally presented with common opportunistic infections and later experienced marked congestive heart failure associated with echocardiographic and radiologic findings consistent with four-chamber cardiomyopathy. Diffuse cardiomyopathy was confirmed postmortem, but in each case a specific cause was not found.