Epicardial adipose tissue volume is greater in men with severe psoriasis, implying an increased cardiovascular disease risk: A cross-sectional study.

BACKGROUND: Patients with psoriasis have elevated risk of coronary artery disease. OBJECTIVE: Do patients with severe psoriasis have larger epicardial adipose tissue volumes (EAT-V) that are associated with cardiovascular risk? METHODS: For this cross-sectional study, we recruited dermatology patients with severe psoriasis and control patients without psoriasis or rheumatologic disease themselves or in a first-degree relative. Participants aged 34 to 55 years without known coronary artery disease or diabetes mellitus underwent computed tomography (CT); EAT-V was obtained from noncontrast CT heart images. RESULTS: Twenty-five patients with psoriasis (14 men, 11 women) and 16 controls (5 men, 11 women) participated. Groups had no statistical difference in age, body mass index, various cardiovascular risk factors (except high-sensitivity C-reactive protein in men), CT-determined coronary artery calcium scores or plaque, or family history of premature cardiovascular disease. Mean EAT-V was greater in the psoriasis group compared to controls (P = .04). There was no statistically significant difference among women; however, male patients with psoriasis had significantly higher EAT-V than controls (P = .03), even when corrected for elevated high-sensitivity C-reactive protein (P = .05). LIMITATIONS: A single-center convenience sample may not be representative. CONCLUSION: Males with psoriasis without known coronary disease or diabetes had greater EAT-V than controls. EAT-V may be an early identifier of those at increased risk for cardiovascular events.

Association Between the 2011 Fibromyalgia Survey Criteria and Multisite Pain Sensitivity in Knee Osteoarthritis.

OBJECTIVES: The present study evaluated the relationship between the 2011 American College of Rheumatology fibromyalgia (FM) survey criteria and quantitative sensory testing (QST). MATERIALS AND METHODS: Patients with knee osteoarthritis scheduled to undergo knee arthroplasty completed the FM survey criteria and self-report measures assessing clinical symptoms. Patients also underwent a battery of QST procedures at the surgical knee and remote body sites, including pressure algometry, conditioned pain modulation, and temporal summation. All assessments were completed before surgery. FM survey criteria were used to calculate a continuous FM score indicating FM severity. RESULTS: A total of 129 patients were analyzed. Of these, 52.7% were female, 93.8% were Caucasian, and 3.8% met the FM survey criteria for FM classification. Mean age for females (63.6 y) and males (64.7 y) was similar. Females and males differed significantly in nearly every outcome, including FM severity, clinical pain, anxiety, depression, and pressure pain sensitivity. In females, FM scores significantly correlated with pressure pain sensitivity, but not conditioned pain modulation or temporal summation, such that increased sensitivity was associated with greater FM severity at all body sites examined. In addition, as FM scores increased, the association between pain sensitivity at the surgical knee and pain sensitivity at remote body sites also increased. No relationship between FM score and QST was observed in males. DISCUSSION: We demonstrated an association between diffuse hyperalgesia as measured by QST and FM severity in females with knee osteoarthritis. These results suggest that the FM survey criteria may represent a marker of pain centralization in females with potential utility in clinical decision making.

Nurse practitioners versus doctors diagnostic reasoning in a complex case presentation to an acute tertiary hospital: a comparative study.

BACKGROUND: Nurse practitioners perform a diagnostic role previously delivered by doctors. Multiple studies demonstrate nurse practitioners are as effective as doctors when managing chronic conditions and minor illnesses and injuries. No studies have focused on how nurse practitioners compare to doctors in their management of complex cases presenting for the first time. OBJECTIVE: This study assessed how nurse practitioners' diagnostic reasoning abilities when managing a complex case compared to those of doctors'? DESIGN: A comparative research design. PARTICIPANTS: Purposeful sampling recruited 30 nurse practitioners and 16 doctors working in multiple specialties in New Zealand. All doctors were completing postgraduate specialist training programmes. Specialties included older adults, emergency care, primary health care/general practice, cardiology, respiratory and palliative care. METHODS: A complex case scenario assessed by an expert panel and think aloud protocol was used to assess diagnostic reasoning abilities. The ability of 30 nurse practitioners to determine diagnoses, identify the problem, and propose actions was compared to that of 16 doctors. Correct responses were determined by an expert panel. Data gained from the case scenario using think aloud protocol were quantified for analysis. RESULTS: 61.9% of doctors identified the correct diagnoses, 56.3% the problem and 34.4% the actions as determined by the expert panel. This compares to 54.7% of nurse practitioners identifying the correct diagnoses, 53.3% the problem and 35.8% the actions. Analysis revealed no difference between these groups (diagnoses 95% CI: -1.76 to -0.32, p=0.17, problem χ(2)=0.00, p=1.0, or actions 95% CI: -1.23 to 1.58, p=0.80). CONCLUSION: Nurse practitioners' diagnostic reasoning abilities compared favourably to those of doctors in terms of diagnoses made, problems identified and action plans proposed from a complex case scenario. In times of global economic restraints this adds further support to alternative models of care.

Perceptions towards lesbian, gay and bisexual people in residential care facilities: a qualitative study.

BACKGROUND: Internationally, increases in the numbers of older people will be reflected in larger numbers of more socioculturally diverse groups of older people requiring care provided by residential care facilities. Covert and overt instances of homophobia are evident within residential care services provided to older lesbian, gay and bisexual people. AIMS: To explore the perceptions of care staff working in residential care homes towards older lesbian, gay and bisexual people. DESIGN: Critical gerontology formed the methodological foundations for focus group discussions with care staff from seven residential care facilities. Hypothetical vignettes were used to stimulate discussion amongst participants. RESULTS: Thematic analysis of the seven focus group interviews illuminated three themes: 'Knowing me knowing you', 'Out of sight out of mind' and 'It's a generational thing'. Subtle as well as not so subtle forms of homophobia were evident in each of the themes. Care staff felt they were largely unprepared to provide care to older lesbian, gay and bisexual people. CONCLUSION: This small-scale New Zealand study identifies that the residential care sector is not always supportive, or prepared, to provide a care service to those people identifying as lesbian, gay and bisexual. IMPLICATIONS FOR PRACTICE: Findings from this study recommend the implementation of principle-based guidelines, opportunities to participate in ongoing education and partnering with non-heterosexual community organisations in order to provide culturally appropriate care to older lesbian, gay and bisexual people.