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On reflection advancing: A brief history regarding midwifery in Western Australia.
Objective Whole-body MRI (WBMRI) is promising for monitoring patients' global disease activity in inflammatory joint diseases. The validation of WBMRI is limited; no studies have evaluated the test-retest agreement (interscan agreement) and only few have assessed the intra- and interreader agreement. Therefore we examined the interscan agreement of WBMRI in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA) and healthy controls (HC); and secondly evaluated the intraand interreader agreement and agreement with conventional hand MRI and determined the distribution of lesions. Methods WBMRI was performed twice with a one-week interval in 14 patients with PsA, 10 with RA and 16 HC. Images were anonymized and read in pairs with unknown chronological order by experienced readers according to the OMERACT WBMRI, the Canada-Denmark MRI and the RAMRIS/PsAMRIS scoring systems. Ten image sets were re-anonymized for assessment of intraand interreader agreement. Agreement was calculated on lesion level by percentage exact agreement (PEA) and Cohen's kappa, and for sum scores by absolute agreement single-measure intraclass correlation coefficient (ICC). Results WBMRI of the spine and peripheral joints and entheses generally showed moderate to almost perfect interscan agreement with PEA ranging from 95-100%, kappa 0.71-1.00 and ICC 0.95-1.00. Intra- and interreader data generally showed moderate to almost perfect agreement. Agreement with conventional MRI varied. More lesions were found in patients than HC. Conclusion WBMRI showed good interscan agreement, implying that repositioning of the patient between examinations does not markedly affect scoring of lesions. Intra- and interreader agreement was moderate to almost perfect.Objective To assess pulmonary function and Chronic Obstructive Pulmonary Disease (COPD) development over time in patients with primary Sjögren's Syndrome (pSS) and the association between pulmonary function, radiographic findings, respiratory symptoms and clinical features of pSS, taking cigarette consumption into account. Methods Forty patients with pSS (mean age 66 yrs, range 42-81 yrs, 39 women), previously participating in a cross-sectional study on pulmonary involvement in pSS, were re-assessed by pulmonary function tests after a mean follow-up time of six years. At follow-up, patients were also assessed by high-resolution computed tomography (HRCT) of the chest and for pSS disease activity, respiratory symptoms and cigarette consumption. Results Patients with pSS showed significantly decreased percentages of predicted total lung capacity (TLC), residual volume (RV), RV/ TLC ratio and diffusing capacity of the lungs for carbon monoxide (DL,CO), and an increased percentage of predicted forced expiratory volume in one second/vital capacity (FEV1/VC) ratio from baseline to follow-up. The proportion of COPD did not change significantly from baseline to follow-up (38% vs. 40%). Radiographic signs of bronchial involvement and interstitial lung disease were found in 38% of the patients, respectively. find more Conclusion Both airway and pulmonary parenchymal disease were commonly found in pSS patients, with a co-existence of both an obstructive and a restrictive pulmonary function pattern, where the latter tended to deteriorate over time. COPD was still a common finding. Airway and pulmonary involvement may be underdiagnosed in pSS, why special attention to clinical assessment of pulmonary involvement in pSS patients is mandated.Objective To determine if a one-year change in walking speed is associated with receiving an incident knee replacement during the following year in adults with and at risk for knee osteoarthritis (OA). Methods Using data from the Osteoarthritis Initiative, we determined a one-year change in 20- meter walk speed from three observation periods (i.e., 0-12, 12-24, and 24-36 month). We operationally defined one-year change in walking speed as either 1) decline 0.1 m/s change. Incident knee replacement was defined using each subsequent one-year period (i.e., 12-24, 24- 36, and 36-48 month). Combining data from the three observation periods, we performed a Poisson regression with robust error variance to determine the relative risk between a change in walking speed (exposure) and incident knee replacement over the following year (outcome). Results Of the 4,264 participants included within this analysis (11,311 total person visits), 115 (3%) adults received a knee replacement. Decline in walking speed was associated with a 104% increase in risk [adjusted relative risk (RR)=2.04; 95% confidence interval (CI)= 1.40-2.98], while an increase in walking speed associated with a 55% decrease in risk (RR=0.45; 95% CI=0.22-0.93) of incident knee replacement in the following year compared to a person with no change in walking speed. Conclusion A one-year decline in walking speed is associated with an increased risk, while one-year increase in walking speed is associated with a decreased risk of future incident knee replacement.Objective Early diagnosis of systemic sclerosis (SSc) is imperative and Raynaud's phenomenon (RP) is an important component of progressive vasculopathy. Nailfold videocapillaroscopy (NVC) is a wellestablished tool that can quantify structural vascular abnormalities. Digital thermal monitoring (DTM) assesses microvascular functional dysfunction related to thermoregulation. In this study, we investigated the correlation of NVC patterns and DTM variables in SSc patients. Methods Patients with SSc by 2013 ACR/EULAR criteria that were consented into the clinical care registry had NVC and DTM performed. For NVC, the number of capillaries (density), measurement of apical diameter (dimension), presence or absence of hemorrhages and number of abnormal shapes were assessed to categorize three different qualitative patterns 'early', 'active' and 'late'. For DTM, Doppler ultrasound hyperemic, low frequency, blood velocity of radial artery and fingertip vascular function was assessed and a vascular reactive index (VRI) measurement was automated. Statistical evaluation was performed by non-parametric tests to assess the correlation of NVC and VRI. Results Thirty-one SSc subjects with interpretable NVC and DTM performed on the same day were included in the study. VRI was progressively higher in SSc patients with the 'early', 'active' and 'late' NVC patterns of microangiopathy (p less then 0.0001). There was a significant negative correlation between VRI and microhemorrhages score (r=-0.363, p=0.044). Conclusion Our study suggests that more advanced vasculopathy correlates to reduced microvascular function as detected by DTM and more advanced structural abnormalities detected by NVC. NVC and DTM may provide different aspects of vasculopathy quantification and complement each other as investigative tools.
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