Inducing a blind spot: blinding data collectors in an investigation of experimental pain.

OBJECTIVE: Methods of blinding have been infrequently investigated. This study assessed data collector blinding within an investigation of endogenous pain modulation. DESIGN: Participants (N = 33; 52% women) were randomly assigned to an order of an exercise bout with intramuscular control injections, quiet rest with intramuscular algesic injections, and a control condition. Data collectors (N = 4; 50% women) recorded participants' pain responses and then left the room before the injection and exercise procedures were administered by other personnel. Immediately after the procedures, the data collectors returned to collect additional pain responses and record their suspicions regarding the assigned condition, their confidence level in their suspicions (0-100 mm scale), and the reason/s for their suspicions. RESULTS: Data collectors correctly identified control and algesic injections in 90.4 and 73.1% of the sessions, respectively, and quiet rest and exercise in 94.2 and 69.2% of the sessions, respectively. The confidence of the data collectors in their suspicions was 60.17 mm (SD = 34.54) for injections and 62.19 mm (SD = 34.95) for exercise. However, data collectors only had correct suspicions and confidence of at least 90 mm for 26.2% of the injections and 29.4% of the exercise bouts. Participants' pain responses were the primary reason for data collectors' suspicions. Neither the amount of experience nor the sexual composition of the participant-data collector dyad influenced the blinding. CONCLUSIONS: Collection of participants' pain responses led to frequent episodes of unblinding. However, it may be misleading to only consider the frequency of correct suspicions as successful or unsuccessful blinding.

New directions in fibromyalgia.

Fibromyalgia is a common disorder causing pain, fatigue and sleep disturbances. The differential diagnosis includes rheumatic diseases and a variety of other conditions. New diagnostic guidelines emphasize the multiple somatic symptoms that may be seen. Pharmacological and nonpharmacological treatment options are available. Three new medications were recently approved for treatment.

The forgotten crystal arthritis: calcium pyrophosphate deposition.

Calcium pyrophosphate crystals are related to a variety of articular manifestations known as calcium pyrophosphate deposition (CPPD) arthritis. Acute CPPD arthritis is commonly known as pseudogout, but there are many other presentations. Diverse endocrine and metabolic diseases may be related to CPPD arthritis. Septic arthritis is in the differential diagnosis of acute CPPD arthritis. The treatment options for CPPD arthritis include non-steroidal anti-inflammatories and steroids.

Assessment of email communication skills of rheumatology fellows: a pilot study.

Physician-patient email communication is gaining popularity. However, a formal assessment of physicians' email communication skills has not been described. We hypothesized that the email communication skills of rheumatology fellows can be measured in an objective structured clinical examination (OSCE) setting using a novel email content analysis instrument which has 18 items. During an OSCE, we asked 50 rheumatology fellows to respond to a simulated patient email. The content of the responses was assessed using our instrument. The majority of rheumatology fellows wrote appropriate responses scoring a mean (±SD) of 10.6 (±2.6) points (maximum score 18), with high inter-rater reliability (0.86). Most fellows were concise (74%) and courteous (68%) but not formal (22%). Ninety-two percent of fellows acknowledged that the patient's condition required urgent medical attention, but only 30% took active measures to contact the patient. No one encrypted their messages. The objective assessment of email communication skills is possible using simulated emails in an OSCE setting. The variable email communication scores and incidental patient safety gaps identified, suggest a need for further training and defined proficiency standards for physicians' email communication skills.