The utility of fluorine-18-fluorodeoxyglucose positron emission tomography in the diagnosis and monitoring of large vessel vasculitis: A South Australian retrospective audit.

AIMS: To investigate the utility of fluorine-18-labelled deoxyglucose positron emission tomography (FDG-PET) in routine clinical practice to diagnose and monitor disease activity and treatment response in large vessel vasculitis in a South Australian cohort. METHODS: We performed a retrospective clinical audit of adult patients who received a FDG-PET at a tertiary referral center between August 2010 and August 2015, where the term "vasculitis" appeared in either the request or report. RESULTS: A total of 45 patients met the inclusion criteria. Nine patients (20%) had a positive FDG-PET for large vessel vasculitis. FDG-PET was positive in 3/6 (50%) patients who met the American College of Rheumatology (ACR) criteria for giant cell arteritis or Takayasu's arteritis (TA) on retrospective review. A positive FDG-PET for large vessel inflammation assisted the primary clinician in making the diagnosis of unclassified large vessel vasculitis in six patients. Four of the seven patients who had more than one scan for large vessel vasculitis demonstrated normalized FDG uptake on subsequent scans after a period on glucocorticoid treatment. The remaining three patients persisted in having increased FDG uptake on FDG-PET imaging while on active treatment. CONCLUSION: Fluorine-18-labelled deoxyglucose positron emission tomography has a role in the diagnosis of large vessel vasculitis, particularly in patients with a high suspicion of active large vessel vasculitis who do not meet the ACR criteria. FDG-PET may have a role in monitoring disease activity in selected patients with large vessel vasculitis especially in identifying occult sites of large vessel inflammation or to titrate prednisolone therapy.

Managing pain in prison: staff perspectives.

PURPOSE: The purpose of this paper is to present the findings of one part of a larger study, funded by the National Institute for Health Research, which explored the management of pain in adult male prisoners in one large category B prison in England. In this paper, the authors focus on the attitudes and perceptions of prison staff towards pain management in prison. DESIGN/METHODOLOGY/APPROACH: A qualitative design was utilised to explore the staff perceptions of pain and pain management in one adult male prison. Questionnaires were provided for all staff with prisoner contact, and a follow up focus group was undertaken to further explore questionnaire data. FINDINGS: The questionnaire and focus group findings demonstrated that staff had a good awareness of pain and pain management in prison, with both physical and emotional pain identified. The frequency of approaches by prisoners to staff for pain relief was noted to be high, whilst awareness of how the prison environment could potentially exacerbate pain was discussed. The acquisition of analgesia by prisoners for secondary gain was identified as a challenge to both assessing levels of pain and providing pain relief in prison, illustrating the complexity of providing care within a custodial culture. The effect on staff of caring for prisoners found to be confrontational and deceitful was significant for participants, with feelings of anger and frustration reported. Research LIMITATIONS/IMPLICATIONS: This study was undertaken in one adult male category B prison with a very high turnover of prisoners. Staff working in other types of prison, for example, higher security or those more stable with longer sentenced prisoners could provide alternative views, as may staff caring for younger offenders and women. The challenges to undertaking research in prison with staff who can understandably be reluctant to engage in reflection on their practice cannot be underestimated and impact significantly on available methodologies. ORIGINALITY/VALUE: This qualitative research is the first of its kind to offer the perspectives of both health care professionals and prison staff working with prisoners complaining of pain in an English prison. It provides the groundwork for further research and development.