Canadian Rheumatologists' Perspectives on Moderate Psoriatic Arthritis and Oligoarticular Psoriatic Arthritis.

OBJECTIVE: Psoriatic arthritis (PsA) substantially impairs quality of life. Clinical trials generally focus on polyarticular PsA, but less is known about the assessment and management of oligoarticular and moderate PsA. An online survey was conducted to determine Canadian rheumatologists' perspectives on the definition and treatment of oligoarticular and moderate PsA. METHODS: Regional and national experts treating patients with PsA were asked to complete an online survey to assess their approach to identifying and managing patients with PsA. Survey questions were developed based on guidance from a committee of Canadian rheumatologists. RESULTS: Sixty-four of 78 rheumatologists responded, representing 6 major Canadian provinces. Nearly half of respondents were in practice > 20 years. The majority of rheumatologists reported using swollen joint count (SJC) to describe moderate PsA (86.4%) and oligoarticular PsA (96.7%), and considered location of inflammation in PsA assessments. SJC cutoff scores for reporting moderate PsA varied among rheumatologists, suggesting lack of an agreed-upon definition for moderate PsA. Sixty-eight percent of rheumatologists identified access to treatment as the greatest challenge with oligoarticular PsA. CONCLUSION: According to the surveyed rheumatologists, SJC remains a key assessment variable when defining oligoarticular and moderate PsA. Although the number of joints is considered when determining the effect of PsA on patients, joint location and functional impairment are also considered when describing the disease as moderate. Access to treatment for patients with < 5 affected joints is challenging.

The use of troponin in general practice.

BACKGROUND: General practitioners are able to measure cardiac troponin in order to help triage patients with symptoms suspicious of acute coronary syndrome. The aim of this study was to assess the utilisation of cardiac troponin testing in the community. METHODS: An audit of all cardiac troponin testing in an urban community from a single laboratory in 2010 was performed. Data regarding admissions and adverse events over a 6-month period was carried out in all patients. RESULTS: Cardiac troponin was measured during 2662 patient events during 2010. There were 223 patients episodes (8.4%) in which greater than and equal to 1 troponin result was elevated, 184 (82.5%) were admitted to hospital, 101 (54.9%) were diagnosed as acute coronary syndrome. Of the 2439 with normal troponin results, 344 (14.1%) were admitted, 42 (12.2%) were diagnosed as acute coronary syndrome. Only 12.1% had serial troponin measurements. The 6-month rates of death were 8.5% versus 1.1%, myocardial infarction were 2.2% versus 1.2%, revascularisation were 1.8% versus 0.7%, heart failure were 3.1% versus 1.0% in those with elevated versus normal troponin respectively. CONCLUSION: The use of troponin in the community appropriately triages patients regarding the need for admission. However, many patients had elevated troponin due to non-coronary causes. The indication for testing only in cases of suspected ACS and the use of serial cTn measurement in early presenters should be emphasised.

Crying and spilling--time to stop the overmedicalisation of normal infant behaviour.

Many infants have periods of unsettledness, or irritability, over the first months of life. Spilling (or posseting) due to reflux of gastric contents is also seen very frequently. Almost universally, these are normal patterns of infancy (the first 12 months of life) that resolve with the passage of time. In recent years, these normal developmental processes have increasingly been ascribed to pathology and treated with medical therapies, including acid suppressants. There is clear evidence, however, that acid suppression has no role in the management of these behaviours. In addition, recent data illustrate increased risk of adverse effects of these drugs in infants.

Estimation of arousal using decomposed skin conductance features - biomed 2009.

Electrodermal response (EDR) shows characteristic signal patterns that correspond to different emotional states. The first major step in using EDR for estimation of emotional state is the separation of various tonic and phasic components. This separation of components is more challenging when the responses overlap each other as they do when responding within shorter inter-stimulus interval. A mathematical model fitting procedure, which separates these overlapping components, is used in an experiment, where participants (n=18) were shown stimuli from the International Affective Picture System (IAPS), which varied by levels of arousal and valance. The EDR signal is collected during the experiment, and features are extracted using the mathematical model fitting procedure. These features are further used, to classify the EDR signal into high versus low arousal responses. A simple k-nearest neighbor algorithm is used to classify the features with 74% accuracy. The accuracy level obtained by a single sensor emphasizes the fact that use of specific feature extraction methods for multi-sensor applications is critical to the classification accuracy. We discuss these results in relation to adaptive system trainer design where multiple biosensors are currently being explored to assess the cognitive state of the learner.

Markers for enhancing team cognition in complex environments: the power of team performance diagnosis.

Team cognition has been identified as a key component to achieve mission goals in dynamic, team-based, stressful, distributed and multicultural operations. Effective team performance in complex environments requires that team members hold a shared understanding of the task, their equipment, and their teammates. So, many of the simulation-based training (SBT) systems and programs have been designed (partly) to enhance shared/team cognition. However, these simulation systems lack the sufficient robustness in their performance assessment tools or capabilities (if they have any) to allow for a rich and deep understanding of team cognition. Therefore, the purpose of this article is fourfold: I) to present a brief account of team cognition; 2) to develop the concept of performance diagnosis and present SBT as an approach to the performance diagnosis of team cognition; 3) to present a set of illustrative behavioral markers of team cognition; and 4) to explicate how these elements (performance diagnosis, team cognition, and SBT) can be leveraged to increase training effectiveness through the development of performance profiles--a rich, detailed, and informative set of metrics--and cognitive and behavioral indicators or illustrative markers of team cognition. Research needs are discussed in terms of realizing the potential of this approach in operational and embedded training contexts.